Renin-Angiotensin System Blockade is Associated with Exercise Capacity, Sympathetic Activity and Endothelial Function in Patients with Chronic Kidney Disease

Background: Chronic kidney disease (CKD) patients have exercise intolerance and exaggerated blood pressure reactivity during exercise that are mediated by sympathetic nervous system (SNS) overactivation and decreased nitric oxide (NO) bioavailability. Activation of the renin-angiotensin system (RAS)...

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Autores principales:	Jin Hee Jeong, Justin D. Sprick, Dana DaCosta, Arshed A. Quyyumi, Jeanie Park
Formato:	article
Lenguaje:	EN
Publicado:	Karger Publishers 2021
Materias:	Dermatology RL1-803 Diseases of the circulatory (Cardiovascular) system RC666-701 Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/f21aa6a42ab54375a2a0aa67b6373cb0
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spelling	oai:doaj.org-article:f21aa6a42ab54375a2a0aa67b6373cb02021-12-02T12:40:22ZRenin-Angiotensin System Blockade is Associated with Exercise Capacity, Sympathetic Activity and Endothelial Function in Patients with Chronic Kidney Disease1420-40961423-014310.1159/000520760https://doaj.org/article/f21aa6a42ab54375a2a0aa67b6373cb02021-11-01T00:00:00Zhttps://www.karger.com/Article/FullText/520760https://doaj.org/toc/1420-4096https://doaj.org/toc/1423-0143Background: Chronic kidney disease (CKD) patients have exercise intolerance and exaggerated blood pressure reactivity during exercise that are mediated by sympathetic nervous system (SNS) overactivation and decreased nitric oxide (NO) bioavailability. Activation of the renin-angiotensin system (RAS) increases SNS activation and reduces NO synthesis, and prior studies suggest that RAS blockade attenuates declines in physical function. We hypothesized that RAS inhibitor (RASi) use is associated with higher exercise capacity mediated by decreased SNS activity and increased NO-dependent endothelial function in CKD. Method: In 35 CKD patients (57 ± 7 years) and 20 controls (CON, 53 ± 8 years), we measured exercise capacity (VO2peak), muscle sympathetic nervous activity (MSNA) and flow-mediated dilation (FMD) for NO-dependent endothelial function. Results: CKD patients treated with RASi (CKD+RASi, n=25) had greater VO2 peak compared to CKD patients not treated with RASi (CKD no RASi, n=10), but lower VO2 peak compared to CON (23.3 ± 5.8 vs.16.4 ± 2.9, p=0.007; vs.30.0 ± 7.7, p=0.016 ml/min/kg respectively). CKD+RASi had lower resting MSNA and greater FMD compared to CKD no RASi. Compared to CON, CKD+RASi had similar MSNA but lower FMD. VO2 peak was positively associated with FMD (r=0.417, p=0.038) and was predicted by the combination of FMD and RASi status (r2 =0.344, p=0.01) and MSNA and RASi status (r2 =0.575, p=0.040) in CKD patients. Conclusion: In summary, CKD patients on RASi have higher exercise capacity compared to those not on RASi. Higher exercise capacity in RASi-treated group was associated with lower resting SNS activity and higher NO-dependent vascular endothelial function.Jin Hee JeongJustin D. SprickDana DaCostaArshed A. QuyyumiJeanie ParkKarger PublishersarticleDermatologyRL1-803Diseases of the circulatory (Cardiovascular) systemRC666-701Diseases of the genitourinary system. UrologyRC870-923ENKidney & Blood Pressure Research (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Dermatology RL1-803 Diseases of the circulatory (Cardiovascular) system RC666-701 Diseases of the genitourinary system. Urology RC870-923
spellingShingle	Dermatology RL1-803 Diseases of the circulatory (Cardiovascular) system RC666-701 Diseases of the genitourinary system. Urology RC870-923 Jin Hee Jeong Justin D. Sprick Dana DaCosta Arshed A. Quyyumi Jeanie Park Renin-Angiotensin System Blockade is Associated with Exercise Capacity, Sympathetic Activity and Endothelial Function in Patients with Chronic Kidney Disease
description	Background: Chronic kidney disease (CKD) patients have exercise intolerance and exaggerated blood pressure reactivity during exercise that are mediated by sympathetic nervous system (SNS) overactivation and decreased nitric oxide (NO) bioavailability. Activation of the renin-angiotensin system (RAS) increases SNS activation and reduces NO synthesis, and prior studies suggest that RAS blockade attenuates declines in physical function. We hypothesized that RAS inhibitor (RASi) use is associated with higher exercise capacity mediated by decreased SNS activity and increased NO-dependent endothelial function in CKD. Method: In 35 CKD patients (57 ± 7 years) and 20 controls (CON, 53 ± 8 years), we measured exercise capacity (VO2peak), muscle sympathetic nervous activity (MSNA) and flow-mediated dilation (FMD) for NO-dependent endothelial function. Results: CKD patients treated with RASi (CKD+RASi, n=25) had greater VO2 peak compared to CKD patients not treated with RASi (CKD no RASi, n=10), but lower VO2 peak compared to CON (23.3 ± 5.8 vs.16.4 ± 2.9, p=0.007; vs.30.0 ± 7.7, p=0.016 ml/min/kg respectively). CKD+RASi had lower resting MSNA and greater FMD compared to CKD no RASi. Compared to CON, CKD+RASi had similar MSNA but lower FMD. VO2 peak was positively associated with FMD (r=0.417, p=0.038) and was predicted by the combination of FMD and RASi status (r2 =0.344, p=0.01) and MSNA and RASi status (r2 =0.575, p=0.040) in CKD patients. Conclusion: In summary, CKD patients on RASi have higher exercise capacity compared to those not on RASi. Higher exercise capacity in RASi-treated group was associated with lower resting SNS activity and higher NO-dependent vascular endothelial function.
format	article
author	Jin Hee Jeong Justin D. Sprick Dana DaCosta Arshed A. Quyyumi Jeanie Park
author_facet	Jin Hee Jeong Justin D. Sprick Dana DaCosta Arshed A. Quyyumi Jeanie Park
author_sort	Jin Hee Jeong
title	Renin-Angiotensin System Blockade is Associated with Exercise Capacity, Sympathetic Activity and Endothelial Function in Patients with Chronic Kidney Disease
title_short	Renin-Angiotensin System Blockade is Associated with Exercise Capacity, Sympathetic Activity and Endothelial Function in Patients with Chronic Kidney Disease
title_full	Renin-Angiotensin System Blockade is Associated with Exercise Capacity, Sympathetic Activity and Endothelial Function in Patients with Chronic Kidney Disease
title_fullStr	Renin-Angiotensin System Blockade is Associated with Exercise Capacity, Sympathetic Activity and Endothelial Function in Patients with Chronic Kidney Disease
title_full_unstemmed	Renin-Angiotensin System Blockade is Associated with Exercise Capacity, Sympathetic Activity and Endothelial Function in Patients with Chronic Kidney Disease
title_sort	renin-angiotensin system blockade is associated with exercise capacity, sympathetic activity and endothelial function in patients with chronic kidney disease
publisher	Karger Publishers
publishDate	2021
url	https://doaj.org/article/f21aa6a42ab54375a2a0aa67b6373cb0
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Renin-Angiotensin System Blockade is Associated with Exercise Capacity, Sympathetic Activity and Endothelial Function in Patients with Chronic Kidney Disease

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