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Published ahead of print on October 15, 2008
Clin J Am Soc Nephrol 3: 1660-1668, 2008
© 2008 American Society of Nephrology
doi: 10.2215/CJN.02920608
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Clinical Nephrology

Physical Activity and Hemodynamic Reactivity in Chronic Kidney Disease

Rajiv Agarwal, and Robert P. Light

Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana

Correspondence: Dr. Rajiv Agarwal, Department of Medicine, Indiana University and VAMC, 1481 West 10th Street, Indianapolis, IN 46202. Phone: 317-988-2241; Fax: 317-988-2171; E-mail: ragarwal{at}iupui.edu

Background and objectives: Patients with chronic kidney disease (CKD) have an elevated cardiovascular risk. This study was designed to understand better the presence and strength of the relationship between physical activity and BP and to explore determinants of hemodynamic reactivity.

Design, setting, participants, & measurements: Twenty-four patients with CKD (mean age 69.5 yr; 3.1 antihypertensive drugs; estimated GFR 47 ml/min per 1.73 m2, albumin/creatinine ratio 403 mg/g) were studied on three occasions during a 6-wk period with 24-h ambulatory BP monitoring and simultaneous activity monitoring with wrist actigraphy.

Results: Nondippers were found have a greater level of sleep activity compared with dippers, although the awake activity level was similar (7.06 versus 6.73) between groups (P = 0.042 for interaction). In 3587 BP activity pairs, hemodynamic reactivity was variable between individuals (systolic BP reactivity 1.06 [SD 10.50]; diastolic BP reactivity 0.89 [SD 7.80] heart rate reactivity 1.18 [SD 11.00]); those who were more sedentary had a greater increment in systolic BP compared with those who were less sedentary. Antihypertensive drugs blunted hemodynamic reactivity. Hemodynamic reactivity was greatest between 12 a.m. and 8 a.m., making this a vulnerable period for cardiovascular events.

Conclusions: Greater hemodynamic reactivity in sedentary people with CKD offers a possible and thus far unrecognized mechanism of cardiovascular damage. Besides reducing BP, antihypertensive drugs reduce hemodynamic reactivity, which offers another plausible mechanism of cardiovascular protection with their use.




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F. Bangash and R. Agarwal
Masked Hypertension and White-Coat Hypertension in Chronic Kidney Disease: A Meta-analysis
Clin. J. Am. Soc. Nephrol., March 1, 2009; 4(3): 656 - 664.
[Abstract] [Full Text] [PDF]


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