Patients with chronic kidney disease (CKD) and/or end-stage renal disease are less
active and experience significant functional limitations. The impact of a structured
aerobic exercise intervention on outcomes in ambulatory heart failure (HF) patients
with comorbid CKD is unknown. HF-ACTION enrolled 2,331 outpatients with HF and a reduced ejection fraction (i.e., ≤35%) from
April 2003 to February 2007 and randomized them to aerobic exercise training versus
usual care. Patients were grouped according to the presence of CKD, defined as an
estimated glomerular filtration rate <60 ml/min/1.73 m2. A total of 2,091 patients (90%) had serum creatinine measured and were included
in the final analytical cohort. The prevalence of CKD was 41% at baseline. In patients
with and without CKD, respectively, the incidence of all-cause death and hospitalization
was 75% and 63% over a median follow-up of 30 months. After adjusting for potential
confounders, CKD was associated with increased risk of the composite of all-cause
mortality and hospitalization (hazard ratio 1.18, 95% confidence interval 1.04 to
1.33; p value ≤0.01). With the exception of a marginally greater improvement in exercise
duration in response to aerobic exercise training (estimate ± standard error: 0.9
± 0.2 minutes vs 1.4 ± 0.1 minutes; p value = 0.01), there was no interaction between
treatment arm and CKD on functional status, health-related quality of life, or clinical
outcomes (p value ≥0.05 for all interactions). In conclusion, the prevalence of CKD
was high in ambulatory reduced ejection fraction patients and was associated with
a poorer overall prognosis but not a differential response to aerobic exercise training.
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Article Info
Publication History
Published online: June 23, 2018
Accepted:
June 6,
2018
Received in revised form:
June 4,
2018
Received:
April 21,
2018
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