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- W2010952999 abstract "As discussed in an editorial1Painter P. Johansen K.L. Improving physical functioning: Time to be a part of routine care.Am J Kidney Dis. 2006; 48 (editorial): 167-170Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar accompanying Hsieh et al’s report about cardiovascular fitness in hemodialysis patients,2Hsieh R.-L. Lee W.-C. Chang C.-H. Maximal cardiovascular fitness and its correlates in ambulatory hemodialysis patients.Am J Kidney Dis. 2006; 48: 21-27Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar many studies have quantified physical impairment of hemodialysis patients. Previously in this journal, we reported a multivariate analysis of factors affecting exercise capacity among 193 dialysis patients.3Sietsema K.E. Hiatt W.R. Esler A. Adler S. Amato A. Brass E.P. Clinical and demographic predictors of exercise capacity in end-stage renal disease.Am J Kidney Dis. 2002; 39: 76-85Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar Our findings differed from those of Hsieh et al in identifying a larger number of clinical factors significantly related to peak oxygen uptake (VO2). This difference is likely attributable to our much larger sample size. Less readily explained are the very low peak VO2 values for both their patient and control groups. In series of erythropoietin-treated dialysis patients, peak VO2 generally averages 16 to 20 mL/kg/min or 50% to 60% of appropriate reference values.3Sietsema K.E. Hiatt W.R. Esler A. Adler S. Amato A. Brass E.P. Clinical and demographic predictors of exercise capacity in end-stage renal disease.Am J Kidney Dis. 2002; 39: 76-85Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar, 4Robertson H.T. Haley N.R. Guthrie M. Cardenas D. Eschbach J.W. Adamson J.W. Recombinant erythropoietin improves exercise capacity in anemic hemodialysis patients.Am J Kidney Dis. 1990; 15: 325-332Abstract Full Text PDF PubMed Scopus (125) Google Scholar, 5Lundin A.P. Akerman M.J. Chesler R.M. et al.Exercise in hemodialysis patients after treatment with recombinant human erythropoietin.Nephron. 1991; 58: 315-319Crossref PubMed Scopus (81) Google Scholar, 6Johansen K.L. Physical functioning and exercise capacity in patients on dialysis.Adv Ren Replace Ther. 1999; 6: 141-148PubMed Google Scholar The average peak VO2 of only 11.5 mL/kg/min reported by Hsieh et al could reflect the relatively advanced age, or other characteristics, of their cohort. However, it represents an atypically high percentage of the healthy control group’s mean peak VO2, which is also surprisingly low at only 14.9 mL/kg/min. Although reference values for peak VO2 reported from Asia tend to be lower than from North America,7Ong K.C. Loo C.M. Ong Y.Y. Chan S.P. Earnest A. Saw S.M. Predictive values for cardiopulmonary exercise testing in sedentary Chinese adults.Respirology. 2002; 7: 225-231Crossref PubMed Scopus (27) Google Scholar, 8ATS/ACCPStatement on cardiopulmonary exercise testing.Am J Respir Crit Care Med. 2003; 167: 211-277Crossref PubMed Scopus (2505) Google Scholar the control group’s values appear low even relative to regressions derived specifically from Asian populations,7Ong K.C. Loo C.M. Ong Y.Y. Chan S.P. Earnest A. Saw S.M. Predictive values for cardiopulmonary exercise testing in sedentary Chinese adults.Respirology. 2002; 7: 225-231Crossref PubMed Scopus (27) Google Scholar including an analysis from the authors’ institution.9Hsi W.L. Lan C. Lai J.S. Normal standards for cardiopulmonary responses to exercise using a cycle ergometer test.J Formos Med Assoc. 1998; 97: 315-322PubMed Google Scholar The systematically low peak VO2 measurements in this report raise the question of whether there are unidentified methodological differences between this study and others on this topic. This is important if these data are to be put into the context of previously published literature. ALL LETTERS TO THE EDITOR MUST BE SUBMITTED ONLINE VIA EDITORIAL MANAGER (http://ajkd.edmgr.com). Letters should be in response to an AJKD article, and that article should have appeared no more than 6 months previously. The title must be different from that of the original article. Letters must not exceed 250 words (excluding references, maximum number 10) and contain no more than 1 figure or table. Letters are subject to editing and abridgment without notice and there is no guarantee that your letter will be published. Submitting the letter constitutes your permission for its publication in any current or subsequent issue or edition of AJKD, in any form or media, now known or hereafter developed. ALL LETTERS TO THE EDITOR MUST BE SUBMITTED ONLINE VIA EDITORIAL MANAGER (http://ajkd.edmgr.com). Letters should be in response to an AJKD article, and that article should have appeared no more than 6 months previously. The title must be different from that of the original article. Letters must not exceed 250 words (excluding references, maximum number 10) and contain no more than 1 figure or table. Letters are subject to editing and abridgment without notice and there is no guarantee that your letter will be published. Submitting the letter constitutes your permission for its publication in any current or subsequent issue or edition of AJKD, in any form or media, now known or hereafter developed. Improving Physical Functioning: Time to Be a Part of Routine CareAmerican Journal of Kidney DiseasesVol. 48Issue 1PreviewTHE STUDY BY Hsieh et al “Maximal Cardiovascular Fitness and Its Correlates in Ambulatory Hemodialysis Patients”1 is yet another that documents low levels of physical functioning in hemodialysis patients. Although the authors suggest that studies focusing on maximal cardiovascular fitness in hemodialysis patients are lacking, there are actually many studies that have documented that physical functioning is low in patients with chronic kidney disease (CKD) treated with dialysis. From 1983 to 2005 there were at least 45 published articles documenting low levels of functioning using objective laboratory measures (ie, peak oxygen uptake [peak VO2] or performance-based measures [ie, gait speed, sit-to-stand test]). Full-Text PDF Maximal Cardiovascular Fitness and Its Correlates in Ambulatory Hemodialysis PatientsAmerican Journal of Kidney DiseasesVol. 48Issue 1PreviewBackground: Studies focusing on maximal cardiovascular fitness in ambulatory hemodialysis patients are lacking. The main purpose of this study is to look at maximal cardiovascular fitness in ambulatory hemodialysis patients, and the secondary purpose is to look at correlates with such fitness. Methods: We studied maximal cardiovascular fitness in ambulatory hemodialysis patients and age-matched controls. Correlates of maximal oxygen consumption with functional and physical performance, psychiatric symptoms, cognitive function, quality of life, duration of dialysis therapy, and adequacy of dialysis also were examined. Full-Text PDF In ReplyAmerican Journal of Kidney DiseasesVol. 48Issue 6PreviewI welcome the opportunity to respond to Sietsema’s letter. The peak oxygen uptake (VO2 peak) can be affected by age, height, sex, body composition, comorbidities, mode of exercise, physical activity level, state of training, genetics, and so on.1,2 It is known that heritability accounts for up to 50% to 60 % of the VO2 peak.3-4 Usually 2 modes of exercise test were performed for the measurement of VO2 peak, and the cycle ergometer has 5% to 20% lower VO2 peak values than the treadmill.5 Full-Text PDF" @default.
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