Nephrology Dialysis Transplantation, Vol 14, Issue 5 1182-1187, Copyright © 1999 by Oxford University Press
L McMahon, M McKenna, T Sangkabutra, K Mason, S Sostaric, S Skinner, C Burge, B Murphy and D Crankshaw
Background. To determine the effects of different
haemoglobin (Hb) levels on exercise performance and associated electrolyte
changes, a prospective, randomized, double-blinded crossover study was
completed in 14 haemodialysis patients. Methods.
Performance and changes in arterial [K+]
and lactate were compared at rest and during a maximal incremental cycling
exercise at a Hb concentration ([Hb]) of 10 g/dl ([Hb]10) and 14 g/dl
([Hb]14) following an initial baseline test (Hb: 8.3±0.2 g/dl,
mean±SEM). Ages ranged from 23 to 65 years and patients were
divided into younger (age 23-45 years, n=9) and older
(aged 55-65 years, n=5) groups. Results.
Peak work rate and V02 peak were higher at
[Hb]14 than at [Hb]10. 145±9 vs
134±9 W, &mgr;±SEM,
P<0.01,and 1.90±0.11
vs 1.61±0.11 l/min,
P<0.01 respectively. Improvements were
demonstrated in both younger and older groups at the higher target [Hb],
with an improved aerobic performance evident particularly in younger
patients. However, performance remained below that predicted for comparable
sedentary controls. Resting plasma [K+] was raised
at both [Hb]10 and [Hb]14 compared with baseline
(P<0.01) although the change in
[K+] from rest to peak exercise
(&Dgr;[K+]) was similar at each level. The
&Dgr;[K+] per unit work performed (used as a
marker of K+ regulation) was, however, inversely
related to the [Hb] (baseline: 80±12 &mgr;mol/l/kJ
vs [Hb]10. 61±8,
P<0.01, vs [Hb]14.
49±7, P<0.05). Exercise induced a
significant but similar rise in lactate concentration at both target [Hb]
(P<0.001), which remained markedly elevated for
at least 10 min after exercise in both younger and older groups.
Conclusions. These data demonstrate that a
physiological [Hb] improves, but does not normalize, exercise performance
in end-stage renal failure. Both younger and older patients appear to
benefit similarly from the enhanced oxygen transport. Impaired
K+ regulation is apparently related to [Hb] and
could well contribute to the observed limitations in performance.
Keywords: epoetin; exercise; haemodialysis; normal
haemoglobin; potassium
ORIGINAL ARTICLES
Physical performance and associated electrolyte changes after haemoglobin normalization: a comparative study in haemodialysis patients
Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria 3052, Australia; Department of Human Movement, Recreation and Performance, Centre for Rehabilitation, Exercise and Sports Science, Victoria University of Technology, Melbourne, Australia; Anaesthetic Research and Education Unit, Department of Pharmacology, and Department of Physiology, University of Melbourne, Parkville, Victoria, Australia; Corresponding author
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