Renal Function and Exercise Training in Ambulatory Heart Failure Patients With a Reduced Ejection Fraction

Andrew P. Ambrosy, Hillary Mulder, Adrian Coles, William E. Krauss, Carolyn S.P. Lam, Peter A. McCullough, Ileana L. Pina, Jasper Tromp, David J. Whellan, Christopher M. O'Connor, Robert J. Mentz

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)999-1007
Number of pages9
JournalAmerican Journal of Cardiology
Volume122
Issue number6
DOIs
StatePublished - Sep 15 2018

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Chronic Renal Insufficiency
Heart Failure
Exercise
Kidney
Hospitalization
Glomerular Filtration Rate
Chronic Kidney Failure
Cause of Death
Creatinine
Outpatients
Quality of Life
Confidence Intervals
Mortality
Incidence
Serum

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ambrosy, A. P., Mulder, H., Coles, A., Krauss, W. E., Lam, C. S. P., McCullough, P. A., ... Mentz, R. J. (2018). Renal Function and Exercise Training in Ambulatory Heart Failure Patients With a Reduced Ejection Fraction. American Journal of Cardiology, 122(6), 999-1007. https://doi.org/10.1016/j.amjcard.2018.06.011

Renal Function and Exercise Training in Ambulatory Heart Failure Patients With a Reduced Ejection Fraction. / Ambrosy, Andrew P.; Mulder, Hillary; Coles, Adrian; Krauss, William E.; Lam, Carolyn S.P.; McCullough, Peter A.; Pina, Ileana L.; Tromp, Jasper; Whellan, David J.; O'Connor, Christopher M.; Mentz, Robert J.

In: American Journal of Cardiology, Vol. 122, No. 6, 15.09.2018, p. 999-1007.

Research output: Contribution to journalArticle

Ambrosy, AP, Mulder, H, Coles, A, Krauss, WE, Lam, CSP, McCullough, PA, Pina, IL, Tromp, J, Whellan, DJ, O'Connor, CM & Mentz, RJ 2018, 'Renal Function and Exercise Training in Ambulatory Heart Failure Patients With a Reduced Ejection Fraction', American Journal of Cardiology, vol. 122, no. 6, pp. 999-1007. https://doi.org/10.1016/j.amjcard.2018.06.011
Ambrosy, Andrew P. ; Mulder, Hillary ; Coles, Adrian ; Krauss, William E. ; Lam, Carolyn S.P. ; McCullough, Peter A. ; Pina, Ileana L. ; Tromp, Jasper ; Whellan, David J. ; O'Connor, Christopher M. ; Mentz, Robert J. / Renal Function and Exercise Training in Ambulatory Heart Failure Patients With a Reduced Ejection Fraction. In: American Journal of Cardiology. 2018 ; Vol. 122, No. 6. pp. 999-1007.
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