Clinical Characteristics and Course of Patients Entering Cardiac Rehabilitation with Chronic Kidney Disease: Data from the Italian Survey on Cardiac Rehabilitation
This survey shows the clinical risk profile, resource utilization, pharmacologic treatment, and course of cardiac rehabilitation (CR) programs in patients with chronic kidney disease (CKD). Data from 165 CR units in Italy were collected online from January 28 to February 10, 2008. The study cohort consisted of 2281 patients: 200 CKD patients and 2081 non-CKD patients. CKD patients were older and showed more comorbidity and complications during CR, a more complex clinical course and interventions with less functional evaluation, and a different pattern of drug therapy at hospital discharge. CKD patients had higher mortality during CR programs due to heart failure, respiratory insufficiency, and cognitive impairment. These findings suggest that patients with CKD should not be denied access to CR, provided careful attention to clinical status, possible complications, optimization of drug therapy, and close followup. 1. Introduction Chronic kidney disease (CKD) is a major public health problem, strongly associated with a high cardiovascular mortality [1]. The high prevalence of established traditional risk factors for atherosclerosis such as diabetes, hypertension, and older age and nontraditional risk factors such as high level of homocysteine, lipoprotein (a), fibrinogen, and C-reactive protein in patients with CKD contributes to an accelerated rate of coronary heart disease (CHD) [2]. The American Heart Association scientific statement on kidney disease and cardiovascular disease has recommended that patients with CKD be placed in the highest-risk group for prevention, detection, and treatment of CHD risk factors [3]. CKD is prevalent in patients with CHD and is associated with a poor prognosis [4]. Exercise training alone or as core component of cardiac rehabilitation (CR) programs has several beneficial effects reducing long-term morbidity and mortality [5], preventing cardiac remodelling [6, 7], and improving cardiovascular functional capacity, cardiac symptoms, and quality of life [8]. The improvement of endothelial function [9], the anti-inflammatory properties [10], the improvement of neurohormonal and autonomic balance [11–14], and the reduction of oxidative stress [15] might be some of the putative mechanisms by which exercise training exerts its beneficial effects. Of note, some of the 1 beneficial effects of exercise-based CR observed in the general population of CHD patients have also been reported in CKD patients [16, 17]. To our knowledge, there are no data that specifically describe in large population of patients the prevalence of CKD in
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