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Clinical and Experimental Nephrology

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Open Access 01-01-2019 | Original article

Characterising skeletal muscle haemoglobin saturation during exercise using near-infrared spectroscopy in chronic kidney disease

Authors: Thomas J. Wilkinson, Alice E. M. White, Daniel G. D. Nixon, Douglas W. Gould, Emma L. Watson, Alice C. Smith

Published in: Clinical and Experimental Nephrology | Issue 1/2019

Abstract

Background

Chronic kidney disease (CKD) patients have reduced exercise capacity. Possible contributing factors may include impaired muscle O₂ utilisation through reduced mitochondria number and/or function slowing the restoration of muscle ATP concentrations via oxidative phosphorylation. Using near-infrared spectroscopy (NIRS), we explored changes in skeletal muscle haemoglobin/myoglobin O₂ saturation (SMO₂%) during exercise.

Methods

24 CKD patients [58.3 (± 16.5) years, eGFR 56.4 (± 22.3) ml/min/1.73 m²] completed the incremental shuttle walk test (ISWT) as a marker of exercise capacity. Using NIRS, SMO₂% was measured continuously before, during, and after (recovery) exercise. Exploratory differences were investigated between exercise capacity tertiles in CKD, and compared with six healthy controls.

Results

We identified two discrete phases; a decline in SMO₂% during incremental exercise, followed by rapid increase upon cessation (recovery). Compared to patients with low exercise capacity [distance walked during ISWT, 269.0 (± 35.9) m], patients with a higher exercise capacity [727.1 (± 38.1) m] took 45% longer to reach their minimum SMO₂% (P = .038) and recovered (half-time recovery) 79% faster (P = .046). Compared to controls, CKD patients took significantly 56% longer to recover (i.e., restore SMO₂% to baseline, full recovery) (P = .014).

Conclusions

Using NIRS, we have determined for the first time in CKD, that favourable SMO₂% kinetics (slower deoxygenation rate, quicker recovery) are associated with greater exercise capacity. These dysfunctional kinetics may indicate reduced mitochondria capacity to perform oxidative phosphorylation—a process essential for carrying out even simple activities of daily living. Accordingly, NIRS may provide a simple, low cost, and non-invasive means to evaluate muscle O₂ kinetics in CKD.

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Title: Characterising skeletal muscle haemoglobin saturation during exercise using near-infrared spectroscopy in chronic kidney disease
Authors: Thomas J. Wilkinson
Alice E. M. White
Daniel G. D. Nixon
Douglas W. Gould
Emma L. Watson
Alice C. Smith
Publication date: 01-01-2019
Publisher: Springer Singapore
Published in: Clinical and Experimental Nephrology / Issue 1/2019
Print ISSN: 1342-1751
Electronic ISSN: 1437-7799
DOI: https://doi.org/10.1007/s10157-018-1612-0

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