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Exercise Performance Falls over Time in Patients with Chronic Kidney Disease Despite Maintenance of Hemoglobin Concentration

Murray J. Leikis^*,, Michael J. McKenna, Aaron C. Petersen, Annette B. Kent^*, Kate T. Murphy, James A. Leppik, Xiaofei Gong, and Lawrence P. McMahon^*,

^* Department of Nephrology, Royal Melbourne Hospital and Western Hospital; Department of Medicine, University of Melbourne; and School of Human Movement, Recreation & Performance, Centre for Ageing, Rehabilitation, Exercise and Sport, Victoria University, Melbourne, Australia

Address correspondence to: Dr. Murray Leikis, Wellington Hospital, Department of Renal Medicine, Private Bag 7902, Wellington 6001, New Zealand. Phone: +4-385-5696; Fax: +4-385-5521; E-mail: murray.leikis{at}ccdhb.org.nz

Physical function is limited in patients with kidney disease, although previous studies have been confounded by anemia. What is not clear is how physical performance changes over time as renal function deteriorates. A cohort of 12 patients (10 male, two female; mean ± SD age 49 ± 11 yr) who had stages 3 to 4 chronic kidney disease without previous anemia were examined, and nine were followed for a 2-yr period. Assessments were made of peak oxygen consumption (VO_2peak) by cycle ergometry, leg extension strength, and fatigue on an isokinetic dynamometer and thigh muscle cross-sectional area (TMCSA) by computed tomography. At baseline, creatinine clearance was 31 ± 13 ml/min and hemoglobin concentration ([Hb]) was 129 ± 9g/L. VO_2peak was low (1.88 L/min, 82% of predicted), and maximal isometric voluntary contraction was 188 ± 42 Nm, with a TMCSA of 144 ± 27 cm². VO_2peak correlated with creatinine clearance corrected for body surface area (r = 0.613, P = 0.034) but not to [Hb]. VO_2peak adjusted for patient weight correlated with leg fatigue (r = –0.693, P = 0.012). For those with follow-up tests, there were falls in renal function by 28% (P = 0.007) and VO_2peak by 9% (P = 0.03), whereas [Hb] did not change. Leg strength fell across a range of isokinetic speeds (P = 0.04), whereas no change in TMCSA was observed. In conclusion, exercise performance as measured by aerobic (VO_2peak) and leg strength tests were reduced in patients with stages 3 to 4 chronic kidney disease. As renal function declined over time, there was a corresponding decline in exercise performance even when [Hb] was maintained.