Functional Sympatholysis and Exercise Intolerance in Chronic Kidney Disease
Emory University
Summary
The purpose of this study is to find out why patients with chronic kidney disease (CKD) have poor exercise capacity and what causes an increase in blood pressure during exercise (i.e. increased adrenaline levels, or decreased ability of blood vessels to dilate).
Description
Patients with chronic kidney disease (CKD) suffer from exercise intolerance and poor physical capacity which contributes to increased cardiovascular risk in this patient population. Prior studies have shown that CKD patients have an exaggerated increase in blood pressure (BP) during both static and rhythmic exercise. Such abnormal hemodynamic responses to exercise can contribute to poor physical capacity and abnormal muscle blood flow during exercise in these patients. The goals of this project are to investigate the mechanisms and potential therapies targeting the abnormal hemodynamic respons…
Eligibility
- Age range
- 18–75 years
- Sex
- All
- Healthy volunteers
- Yes
Inclusion Criteria: * Veterans with Stages III and IV Chronic Kidney Disease (CKD) * Kidney transplant recipients with varying degrees of kidney function * Veterans 18-75 years old, without kidney disease, as study controls * Exercise less than 20 minutes twice per week * Willing and able to cooperate with the protocol Exclusion Criteria: * Severe CKD (estimated glomerular filtration rate (eGFR) \< 15 cc/minute) * Metabolic alkalosis (serum bicarbonate \> 28 meq/L) * Ongoing drug or alcohol abuse * Diabetic neuropathy * Any serious systemic disease that might influence survival * Severe ane…
Interventions
- DrugSodium Bicarbonate
Sodium bicarbonate tablet is 650 mg for one tablet. Oral sodium bicarbonate will be given out as 1300mg-2600mg (2-4 pills) prior to each exercise or stretching session. Serum bicarbonate measurements will be monitored throughout the study (at 2 weeks, then every 2-4 weeks thereafter), and bicarbonate dosages will be adjusted to avoid metabolic alkalosis (serum bicarbonate \> 30).
- DrugPlacebo
2-4 placebo pills will be given out prior to each exercise or stretching session.
- BehavioralExercise Training
Exercise training consists of riding a stationary bicycle for 20-45 minutes, 3 times per week, supervised by trained exercise specialists, for 6-12 weeks. The exercise program will follow the guidelines provided by the American College of Sports Medicine (ACSM) for optimizing cardiovascular fitness. Exercise intensity will begin at low levels (50 percent of resting heart rate) and increase to no greater than 80 percent of resting heart rate. Exercise time will progress, depending on subject's progress, from 20 minutes per session at first, to a maximum of 45 minutes. Trained staff members will give instructions throughout each exercise session. Before beginning each exercise session, subjects will be instructed on a warm-up focusing on preparing the legs for activity.
- BehavioralControl to Exercise (Stretching)
Stretching exercise will consist of muscle stretching and toning for 20-45 minutes, 3 times per week, supervised by trained exercise specialists, for 6-12 weeks. Trained staff members will guide subjects with the stretching exercises, and activities are designed to increase flexibility and range of motion. Before beginning each stretching exercise session, subjects will be instructed to warm-up.
Location
- Atlanta VA Medical CenterDecatur, Georgia