Skip to main content

Advertisement

SpringerLink
Log in

Associations between kidney function and outcomes of comprehensive cardiac rehabilitation in patients with heart failure

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Aims

To investigate the impact of baseline kidney function on outcomes following comprehensive cardiac rehabilitation (CR) in patients with heart failure (HF).

Methods

We reviewed a total of 3,727 patients who were admitted for HF treatment. Estimated glomerular filtration rate (eGFR), quadriceps strength (QS), and 6-min walk distance (6MWD) were measured at hospital discharge as a baseline and 5 months thereafter in participants of outpatient comprehensive CR. The association between outpatient CR participation and all-cause events was evaluated using propensity score-matched analysis in subgroups across eGFR stages. The changes in QS and 6MWD following 5-month CR were compared between eGFR stages.

Results

Out of the studied patients, 1585 (42.5%) participated in outpatient CR. After propensity matching for clinical confounders, 2680 patients were included for analysis (pairs of n = 1340 outpatient CR participants and nonparticipants). The participation in outpatient CR was significantly associated with low clinical events in subgroups of eGFR ≥ 60 [hazard ratio (HR): 0.65, 95% confidence interval (CI): 0.51–0.84] and eGFR 45–60 (HR: 0.71, 95% CI: 0.55–0.92), but not in eGFR 30–45 (HR: 0.83, 95% CI: 0.64–1.08) and eGFR < 30 (HR: 0.88, 95% CI: 0.69–1.12). QS and 6MWD were significantly higher after 5-month CR than those at baseline (P < 0.001, respectively), but lower baseline eGFR correlated with lower changes in QS and 6MWD (trend P < 0.001, respectively).

Conclusions

Although low baseline kidney function attenuates the outcomes of CR, outpatient CR seems to be associated with a better prognosis and positive change in physical function in HF patients with low kidney function.

Graphic abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Mentz RJ, Kelly JP, Von Lueder TG et al (2014) Noncardiac comorbidities in heart failure with reduced versus preserved ejection fraction. J Am Coll Cardiol 64:2281–2293

    Article  PubMed  PubMed Central  Google Scholar 

  2. Streng KW, Nauta JF, Hillege HL et al (2018) Non-cardiac comorbidities in heart failure with reduced, mid-range and preserved ejection fraction. Int J Cardiol 271:132–139

    Article  PubMed  Google Scholar 

  3. Damman K, Testani JM (2015) The kidney in heart failure: an update. Eur Heart J 36:1437–1444

    Article  PubMed  PubMed Central  Google Scholar 

  4. House AA, Wanner C, Sarnak MJ et al (2019) Heart failure in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 95:1304–1317

    Article  PubMed  Google Scholar 

  5. Schardong J, MaZ M, Plentz RDM (2018) Muscle atrophy in chronic kidney disease. Adv Exp Med Biol 1088:393–412

    Article  CAS  PubMed  Google Scholar 

  6. Adams GR, Vaziri ND (2006) Skeletal muscle dysfunction in chronic renal failure: effects of exercise. Am J Physiol Renal Physiol 290:F753-761

    Article  CAS  PubMed  Google Scholar 

  7. Taylor RS, Long L, Mordi IR et al (2019) Exercise-based rehabilitation for heart failure: cochrane systematic review, meta-analysis, and trial sequential analysis. JACC Heart Fail 7:691–705

    Article  PubMed  Google Scholar 

  8. O’connor CM, Whellan DJ, Lee KL et al (2009) Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 301:1439–1450

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ambrosy AP, Mulder H, Coles A et al (2018) Renal function and exercise training in ambulatoryheart failure patients with a reduced ejection fraction. Am J Cardiol 122:999–1007

    Article  PubMed  Google Scholar 

  10. Saitoh M, Takahashi T, Sakurada K et al (2013) Factors determining achievement of early postoperative cardiac rehabilitation goal in patients with or without preoperative kidney dysfunction undergoing isolated cardiac surgery. J Cardiol 61:299–303

    Article  PubMed  Google Scholar 

  11. Izawa H, Yoshida T, Ikegame T et al (2019) Standard cardiac rehabilitation program for heart failure. Circ J 83:2394–2398

    Article  PubMed  Google Scholar 

  12. Chen YJ, Sung SH, Cheng HM et al (2017) Performance of AHEAD score in an asian cohort of acute heart failure with either preserved or reduced left ventricular systolic function. J Am Heart Assoc. https://doi.org/10.1161/JAHA.116.004297

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kamiya K, Masuda T, Tanaka S et al (2015) Quadriceps strength as a predictor of mortality in coronary artery disease. Am J Med 128:1212–1219

    Article  PubMed  Google Scholar 

  14. Laboratories ATSCOPSFCPF (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111–117

    Article  Google Scholar 

  15. Group JCSJW (2014) Guidelines for rehabilitation in patients with cardiovascular disease (JCS 2012). Circ J 78:2022–2093

    Article  Google Scholar 

  16. Persinger R, Foster C, Gibson M et al (2004) Consistency of the talk test for exercise prescription. Med Sci Sports Exerc 36:1632–1636

    PubMed  Google Scholar 

  17. Piepoli MF, Conraads V, Corra U et al (2011) Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail 13:347–357

    Article  PubMed  Google Scholar 

  18. Kamiya K, Sato Y, Takahashi T et al (2020) Multidisciplinary cardiac rehabilitation and long-term prognosis in patients with heart failure. Circ Heart Fail 13:006798

    Article  Google Scholar 

  19. Bouillon K, Batty GD, Hamer M et al (2013) Cardiovascular disease risk scores in identifying future frailty: the Whitehall II prospective cohort study. Heart 99:737–742

    Article  CAS  PubMed  Google Scholar 

  20. Roshanravan B, Gamboa J, Wilund K (2017) Exercise and CKD: skeletal muscle dysfunction and practical application of exercise to prevent and treat physical impairments in CKD. Am J Kidney Dis 69:837–852

    Article  PubMed  PubMed Central  Google Scholar 

  21. Del Buono MG, Arena R, Borlaug BA et al (2019) Exercise intolerance in patients with heart failure: JACC state-of-the-art review. J Am Coll Cardiol 73:2209–2225

    Article  PubMed  Google Scholar 

  22. Nakamura T, Kamiya K, Hamazaki N et al (2020) Quadriceps strength and mortality in older patients with heart failure. Can J Cardiol 37(3):476–483

    Article  PubMed  Google Scholar 

  23. Sietsema KE, Amato A, Adler SG et al (2004) Exercise capacity as a predictor of survival among ambulatory patients with end-stage renal disease. Kidney Int 65:719–724

    Article  PubMed  Google Scholar 

  24. Reeves GR, Whellan DJ, O’connor CM et al (2017) A novel rehabilitation intervention for older patients with acute decompensated heart failure: the REHAB-HF pilot study. JACC Heart Fail 5:359–366

    Article  PubMed  PubMed Central  Google Scholar 

  25. Hamazaki N, Kamiya K, Yamamoto S et al (2020) Changes in respiratory muscle strength following cardiac rehabilitation for prognosis in patients with heart failure. J Clin Med 9(4):952

    Article  PubMed Central  Google Scholar 

  26. Colombo PC, Ganda A, Lin J et al (2012) Inflammatory activation: cardiac, renal, and cardio-renal interactions in patients with the cardiorenal syndrome. Heart Fail Rev 17:177–190

    Article  CAS  PubMed  Google Scholar 

  27. Hirai DM, Musch TI, Poole DC (2015) Exercise training in chronic heart failure: improving skeletal muscle O2 transport and utilization. Am J Physiol Heart Circ Physiol 309:H1419-1439

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Taylor RS, Walker S, Smart NA et al (2018) Impact of exercise-based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation: an individual patient data meta-analysis of randomised trials. Eur J Heart Fail 20:1735–1743

    Article  PubMed  Google Scholar 

  29. Mudge AM, Denaro CP, Scott AC et al (2018) Addition of supervised exercise training to a post-hospital disease management program for patients recently hospitalized with acute heart failure: the EJECTION-HF randomized phase 4 trial. JACC Heart Fail 6:143–152

    Article  PubMed  Google Scholar 

  30. Kaminsky LA, Tuttle MS (2015) Functional assessment of heart failure patients. Heart Fail Clin 11:29–36

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by Japan Society for the Promotion of Science Grant-in-Aid (JSPS KAKENHI Grant Number JP19K1922).

Author information

Authors and Affiliations

  1. Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan

    Nobuaki Hamazaki, Kohei Nozaki & Takafumi Ichikawa

  2. Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan

    Kentaro Kamiya, Minako Yamaoka-Tojo & Atsuhiko Matsunaga

  3. Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan

    Shohei Yamamoto, Masashi Yamashita & Shota Uchida

  4. Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan

    Shohei Yamamoto

  5. Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan

    Ryota Matsuzawa

  6. Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan

    Emi Maekawa, Kentaro Meguro & Junya Ako

Authors
  1. Nobuaki Hamazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kentaro Kamiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shohei Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kohei Nozaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takafumi Ichikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ryota Matsuzawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masashi Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shota Uchida
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Emi Maekawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kentaro Meguro
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Minako Yamaoka-Tojo
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Atsuhiko Matsunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Junya Ako
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nobuaki Hamazaki.

Ethics declarations

Conflict of interest

All authors report no conflict of interest related to this manuscript.

Ethical approval

This study protocol was approved by the Kitasato Institute Clinical Research Review Board (KMEO B18-075).

Informed consent

All patients provided informed consent.

Supplementary Information

Below is the link to the electronic supplementary material.

392_2021_1875_MOESM1_ESM.docx

Comparisons between clinical variables before and after the 5-month CR. Orange bars indicate baseline; green bars indicate after 5-month CR. Data, mean and standard error. BMI body mass index, BNP brain natriuretic peptide, CR cardiac rehabilitation, eGFR estimated glomerular filtration rate, QS quadriceps strength, 6MWD 6-min walk distance (TIF 981 kb)

Supplementary file2 (DOCX 32 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hamazaki, N., Kamiya, K., Yamamoto, S. et al. Associations between kidney function and outcomes of comprehensive cardiac rehabilitation in patients with heart failure. Clin Res Cardiol 111, 253–263 (2022). https://doi.org/10.1007/s00392-021-01875-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-021-01875-2

Keywords

Search

Navigation