{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T09:25:35Z","timestamp":1777022735112,"version":"3.51.4"},"reference-count":44,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2016,1,12]]},"published-print":{"date-parts":[[2016,2]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Reduced exercise capacity is well documented in end-stage chronic kidney disease (CKD), preceded by changes in cardiac morphology in CKD stage 3. However, it is unknown whether subclinical cardiopulmonary dysfunction occurs in CKD stage 3 independently of heart failure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Prospective observational cross-sectional study of exercise capacity assessed by cardiopulmonary exercise testing in 993 preoperative patients. Primary outcome was peak oxygen consumption (VO<jats:sub>2peak<\/jats:sub>). Anaerobic threshold (AT), oxygen pulse and exercise-evoked measures of autonomic function were analysed, controlling for CKD stage 3, age, gender, diabetes mellitus and hypertension.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>CKD stage 3 was present in 93\/993 (9.97%) patients. Diabetes mellitus (RR 2.49 (95% CI 1.59 to 3.89); p&lt;0.001), and hypertension (RR 3.20 (95% CI 2.04 to 5.03); p&lt;0.001)) were more common in CKD stage 3. Cardiac failure (RR 0.83 (95% CI 0.30 to 2.24); p=0.70) and ischaemic heart disease (RR 1.40 (95% CI 0.97 to 2.02); p=0.09) were not more common in CKD stage 3. Patients with CKD stage 3 had lower predicted VO<jats:sub>2peak<\/jats:sub> (mean difference: 6% (95% CI 1% to 11%); p=0.02), lower peak heart rate (mean difference:9\u2005bpm (95% CI 3 to 14); p=0.03)), lower AT (mean difference: 1.1\u2005mL\/min\/kg (95% CI 0.4 to 1.7); p&lt;0.001) and impaired heart rate recovery (mean difference: 4\u2005bpm (95% CI 1 to 7); p&lt;0.001)).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Subclinical cardiopulmonary dysfunction in CKD stage 3 is common. This study suggests that maladaptive cardiovascular\/autonomic dysfunction may be established in CKD stage 3, preceding pathophysiology reported in end-stage CKD.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2015-000370","type":"journal-article","created":{"date-parts":[[2016,6,8]],"date-time":"2016-06-08T08:14:51Z","timestamp":1465373691000},"page":"e000370","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Subclinical cardiopulmonary dysfunction in stage 3 chronic kidney disease"],"prefix":"10.1136","volume":"3","author":[{"given":"Alexander","family":"Nelson","sequence":"first","affiliation":[{"name":"UCL Medical School, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Otto","sequence":"additional","affiliation":[{"name":"Royal Free London NHS Foundation Trust, London, 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UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0565-5164","authenticated-orcid":false,"given":"Gareth L","family":"Ackland","sequence":"additional","affiliation":[{"name":"William Harvey Research Institute, Queen Mary University of London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,2,24]]},"reference":[{"key":"2025081710365289000_3.1.e000370.1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1038\/ki.2010.362","article-title":"Kidney function for the non-nephrologist: an emerging tool for predicting mortality risk","volume":"79","author":"Hallan","year":"2011","journal-title":"Kidney Int"},{"key":"2025081710365289000_3.1.e000370.2","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1038\/nrneph.2014.8","article-title":"Noncardiovascular mortality in CKD: an epidemiological perspective","volume":"10","author":"de 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