Altered Exercise Gas Exchange as Related to Microalbuminuria in Type 2 Diabetic Patients
Microalbuminuria in diabetes mellitus is a risk factor for cardiovascular disease. We hypothesized that microalbuminuria in type 2 diabetic patients is related to impaired cardiopulmonary function during exercise, and that the severity of impairment is correlated with the degree of microalbuminuria....
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| Veröffentlicht in: | Chest 2004-04, Vol.125 (4), p.1292-1298 |
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| creator | Lau, Arthur Chun-Wing Lo, Matthew Kwok-Wing Leung, Godwin Tat-Chi Choi, Frankie Pak-Tat Yam, Loretta Yin-Chun Wasserman, Karlman |
| description | Microalbuminuria in diabetes mellitus is a risk factor for cardiovascular disease. We hypothesized that microalbuminuria in type 2 diabetic patients is related to impaired cardiopulmonary function during exercise, and that the severity of impairment is correlated with the degree of microalbuminuria.
Twenty of each of the following categories of subjects performed symptom-limited cardiopulmonary exercise testing on a cycle ergometer: (1) type 2 diabetic patients with normoalbuminuria (daily urinary albumin excretion [UAE] < 30 mg/d); (2) type 2 diabetic patients with microalbuminuria (daily UAE, 30 to 300 mg/d); and (3) normal control subjects.
Oxygen consumption (▪o2) of patients with microalbuminuria was lower than that of control subjects at anaerobic threshold (AT) [p < 0.001], and was lower than both control subjects (p < 0.001) and patients with normoalbuminuria (p = 0.015) at peak exercise. There was a progressive worsening in gas exchange efficiency at the lungs, as measured by minute ventilation (▪e)/carbon dioxide production (▪co2) at AT or Δ▪e/Δ▪co2 slope, (p = 0.006 and p = 0.019, respectively) going from control subjects to patients with normoalbuminuria and then to patients with microalbuminuria. Left ventricular ejection fractions and BP were similar in patients with normoalbuminuria and microalbuminuria. More patients with microalbuminuria (n = 9) than with normoalbuminuria (n = 2) demonstrated diastolic dysfunction (p = 0.013). These 11 patients had lower peak ▪o2 values (p = 0.001) and higher daily UAE (p = 0.028). An inverse linear relationship was found between peak ▪o2 and log10 daily UAE (r = − 0.57, r2 = 0.29, p < 0.001).
Abnormalities reflecting reduced oxygen transport and impaired gas exchange efficiency were found during exercise, and were especially profound in patients with microalbuminuria. These changes could be secondary to pulmonary microangiopathy and myocardial interstitial changes. Increases in capillary permeability to proteins may take place in the myocardium as they do in the kidneys, and contribute to impaired myocardial distensibility and hence diastolic dysfunction. |
| doi_str_mv | 10.1378/chest.125.4.1292 |
| format | Article |
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Twenty of each of the following categories of subjects performed symptom-limited cardiopulmonary exercise testing on a cycle ergometer: (1) type 2 diabetic patients with normoalbuminuria (daily urinary albumin excretion [UAE] < 30 mg/d); (2) type 2 diabetic patients with microalbuminuria (daily UAE, 30 to 300 mg/d); and (3) normal control subjects.
Oxygen consumption (▪o2) of patients with microalbuminuria was lower than that of control subjects at anaerobic threshold (AT) [p < 0.001], and was lower than both control subjects (p < 0.001) and patients with normoalbuminuria (p = 0.015) at peak exercise. There was a progressive worsening in gas exchange efficiency at the lungs, as measured by minute ventilation (▪e)/carbon dioxide production (▪co2) at AT or Δ▪e/Δ▪co2 slope, (p = 0.006 and p = 0.019, respectively) going from control subjects to patients with normoalbuminuria and then to patients with microalbuminuria. Left ventricular ejection fractions and BP were similar in patients with normoalbuminuria and microalbuminuria. More patients with microalbuminuria (n = 9) than with normoalbuminuria (n = 2) demonstrated diastolic dysfunction (p = 0.013). These 11 patients had lower peak ▪o2 values (p = 0.001) and higher daily UAE (p = 0.028). An inverse linear relationship was found between peak ▪o2 and log10 daily UAE (r = − 0.57, r2 = 0.29, p < 0.001).
Abnormalities reflecting reduced oxygen transport and impaired gas exchange efficiency were found during exercise, and were especially profound in patients with microalbuminuria. These changes could be secondary to pulmonary microangiopathy and myocardial interstitial changes. Increases in capillary permeability to proteins may take place in the myocardium as they do in the kidneys, and contribute to impaired myocardial distensibility and hence diastolic dysfunction.</description><identifier>ISSN: 0012-3692</identifier><identifier>EISSN: 1931-3543</identifier><identifier>DOI: 10.1378/chest.125.4.1292</identifier><identifier>PMID: 15078737</identifier><identifier>CODEN: CHETBF</identifier><language>eng</language><publisher>Northbrook, IL: Elsevier Inc</publisher><subject>Albuminuria - etiology ; Anaerobic threshold ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Angina pectoris ; Biological and medical sciences ; Carbon dioxide ; Cardiology. Vascular system ; Cardiovascular disease ; Diabetes ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - physiopathology ; Diabetes Mellitus, Type 2 - urine ; Diabetes. Impaired glucose tolerance ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Exercise ; Female ; gas exchange ; Heart rate ; Hemoglobin ; Hospitals ; Humans ; Male ; Medical sciences ; microalbuminuria ; Middle Aged ; Oxygen Consumption - physiology ; Physical fitness ; Pneumology ; Pulmonary Gas Exchange - physiology ; Recruitment ; Risk factors ; Spirometry ; type 2 diabetes ; Variance analysis</subject><ispartof>Chest, 2004-04, Vol.125 (4), p.1292-1298</ispartof><rights>2004 The American College of Chest Physicians</rights><rights>2004 INIST-CNRS</rights><rights>Copyright American College of Chest Physicians Apr 2004</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c541t-decd5439098637ed13c811baa1873e802a09172b2fa82857bdd27311a4ceab4c3</citedby><cites>FETCH-LOGICAL-c541t-decd5439098637ed13c811baa1873e802a09172b2fa82857bdd27311a4ceab4c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15607766$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15078737$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lau, Arthur Chun-Wing</creatorcontrib><creatorcontrib>Lo, Matthew Kwok-Wing</creatorcontrib><creatorcontrib>Leung, Godwin Tat-Chi</creatorcontrib><creatorcontrib>Choi, Frankie Pak-Tat</creatorcontrib><creatorcontrib>Yam, Loretta Yin-Chun</creatorcontrib><creatorcontrib>Wasserman, Karlman</creatorcontrib><title>Altered Exercise Gas Exchange as Related to Microalbuminuria in Type 2 Diabetic Patients</title><title>Chest</title><addtitle>Chest</addtitle><description>Microalbuminuria in diabetes mellitus is a risk factor for cardiovascular disease. We hypothesized that microalbuminuria in type 2 diabetic patients is related to impaired cardiopulmonary function during exercise, and that the severity of impairment is correlated with the degree of microalbuminuria.
Twenty of each of the following categories of subjects performed symptom-limited cardiopulmonary exercise testing on a cycle ergometer: (1) type 2 diabetic patients with normoalbuminuria (daily urinary albumin excretion [UAE] < 30 mg/d); (2) type 2 diabetic patients with microalbuminuria (daily UAE, 30 to 300 mg/d); and (3) normal control subjects.
Oxygen consumption (▪o2) of patients with microalbuminuria was lower than that of control subjects at anaerobic threshold (AT) [p < 0.001], and was lower than both control subjects (p < 0.001) and patients with normoalbuminuria (p = 0.015) at peak exercise. There was a progressive worsening in gas exchange efficiency at the lungs, as measured by minute ventilation (▪e)/carbon dioxide production (▪co2) at AT or Δ▪e/Δ▪co2 slope, (p = 0.006 and p = 0.019, respectively) going from control subjects to patients with normoalbuminuria and then to patients with microalbuminuria. Left ventricular ejection fractions and BP were similar in patients with normoalbuminuria and microalbuminuria. More patients with microalbuminuria (n = 9) than with normoalbuminuria (n = 2) demonstrated diastolic dysfunction (p = 0.013). These 11 patients had lower peak ▪o2 values (p = 0.001) and higher daily UAE (p = 0.028). An inverse linear relationship was found between peak ▪o2 and log10 daily UAE (r = − 0.57, r2 = 0.29, p < 0.001).
Abnormalities reflecting reduced oxygen transport and impaired gas exchange efficiency were found during exercise, and were especially profound in patients with microalbuminuria. These changes could be secondary to pulmonary microangiopathy and myocardial interstitial changes. Increases in capillary permeability to proteins may take place in the myocardium as they do in the kidneys, and contribute to impaired myocardial distensibility and hence diastolic dysfunction.</description><subject>Albuminuria - etiology</subject><subject>Anaerobic threshold</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Angina pectoris</subject><subject>Biological and medical sciences</subject><subject>Carbon dioxide</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular disease</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - physiopathology</subject><subject>Diabetes Mellitus, Type 2 - urine</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Exercise</subject><subject>Female</subject><subject>gas exchange</subject><subject>Heart rate</subject><subject>Hemoglobin</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>microalbuminuria</subject><subject>Middle Aged</subject><subject>Oxygen Consumption - physiology</subject><subject>Physical fitness</subject><subject>Pneumology</subject><subject>Pulmonary Gas Exchange - physiology</subject><subject>Recruitment</subject><subject>Risk factors</subject><subject>Spirometry</subject><subject>type 2 diabetes</subject><subject>Variance analysis</subject><issn>0012-3692</issn><issn>1931-3543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kE1v1DAQhi1ERZfCnROKkOCWxWMnscOtKqVUagVCReJmTZzZrqt8LHYC9N8zZSOVInGxPdIzM68fIV6AXIM29q3fUprWoMp1wWetHokV1BpyXRb6sVhJCSrXVa0OxdOUbiTXUFdPxCGU0lijzUp8O-4mitRmp78o-pAoO8PEhd_icE0Zv79QhxMD05hdBh9H7Jq5D8McA2ZhyK5ud5Sp7H3Ahqbgs884BRqm9EwcbLBL9Hy5j8TXD6dXJx_zi09n5yfHF7kvC5jylnzLYWtZ20obakF7C9AgAucjKxXKGoxq1AatsqVp2lYZDYCFJ2wKr4_Em_3cXRy_z6zD9SF56jocaJyTM2BBW60ZfPUPeDPOceBsTklZFGVta4bkHuKPphRp43Yx9BhvHUh3p9z9Ue5YuSvcnXJuebnMnZue2vuGxTEDrxcAk8duE3Fg0X9xlTSmqu53b8P19meI5FKPXcdj9X7rkvfB7nf7FmLDPwJFlzzb99Ryu59cO4b_B_8NzaeuDw</recordid><startdate>20040401</startdate><enddate>20040401</enddate><creator>Lau, Arthur Chun-Wing</creator><creator>Lo, Matthew Kwok-Wing</creator><creator>Leung, Godwin Tat-Chi</creator><creator>Choi, Frankie Pak-Tat</creator><creator>Yam, Loretta Yin-Chun</creator><creator>Wasserman, Karlman</creator><general>Elsevier Inc</general><general>American College of Chest Physicians</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20040401</creationdate><title>Altered Exercise Gas Exchange as Related to Microalbuminuria in Type 2 Diabetic Patients</title><author>Lau, Arthur Chun-Wing ; Lo, Matthew Kwok-Wing ; Leung, Godwin Tat-Chi ; Choi, Frankie Pak-Tat ; Yam, Loretta Yin-Chun ; Wasserman, Karlman</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c541t-decd5439098637ed13c811baa1873e802a09172b2fa82857bdd27311a4ceab4c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Albuminuria - etiology</topic><topic>Anaerobic threshold</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Angina pectoris</topic><topic>Biological and medical sciences</topic><topic>Carbon dioxide</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular disease</topic><topic>Diabetes</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes Mellitus, Type 2 - physiopathology</topic><topic>Diabetes Mellitus, Type 2 - urine</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Exercise</topic><topic>Female</topic><topic>gas exchange</topic><topic>Heart rate</topic><topic>Hemoglobin</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>microalbuminuria</topic><topic>Middle Aged</topic><topic>Oxygen Consumption - physiology</topic><topic>Physical fitness</topic><topic>Pneumology</topic><topic>Pulmonary Gas Exchange - physiology</topic><topic>Recruitment</topic><topic>Risk factors</topic><topic>Spirometry</topic><topic>type 2 diabetes</topic><topic>Variance analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lau, Arthur Chun-Wing</creatorcontrib><creatorcontrib>Lo, Matthew Kwok-Wing</creatorcontrib><creatorcontrib>Leung, Godwin Tat-Chi</creatorcontrib><creatorcontrib>Choi, Frankie Pak-Tat</creatorcontrib><creatorcontrib>Yam, Loretta Yin-Chun</creatorcontrib><creatorcontrib>Wasserman, Karlman</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Chest</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lau, Arthur Chun-Wing</au><au>Lo, Matthew Kwok-Wing</au><au>Leung, Godwin Tat-Chi</au><au>Choi, Frankie Pak-Tat</au><au>Yam, Loretta Yin-Chun</au><au>Wasserman, Karlman</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Altered Exercise Gas Exchange as Related to Microalbuminuria in Type 2 Diabetic Patients</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>2004-04-01</date><risdate>2004</risdate><volume>125</volume><issue>4</issue><spage>1292</spage><epage>1298</epage><pages>1292-1298</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><coden>CHETBF</coden><abstract>Microalbuminuria in diabetes mellitus is a risk factor for cardiovascular disease. We hypothesized that microalbuminuria in type 2 diabetic patients is related to impaired cardiopulmonary function during exercise, and that the severity of impairment is correlated with the degree of microalbuminuria.
Twenty of each of the following categories of subjects performed symptom-limited cardiopulmonary exercise testing on a cycle ergometer: (1) type 2 diabetic patients with normoalbuminuria (daily urinary albumin excretion [UAE] < 30 mg/d); (2) type 2 diabetic patients with microalbuminuria (daily UAE, 30 to 300 mg/d); and (3) normal control subjects.
Oxygen consumption (▪o2) of patients with microalbuminuria was lower than that of control subjects at anaerobic threshold (AT) [p < 0.001], and was lower than both control subjects (p < 0.001) and patients with normoalbuminuria (p = 0.015) at peak exercise. There was a progressive worsening in gas exchange efficiency at the lungs, as measured by minute ventilation (▪e)/carbon dioxide production (▪co2) at AT or Δ▪e/Δ▪co2 slope, (p = 0.006 and p = 0.019, respectively) going from control subjects to patients with normoalbuminuria and then to patients with microalbuminuria. Left ventricular ejection fractions and BP were similar in patients with normoalbuminuria and microalbuminuria. More patients with microalbuminuria (n = 9) than with normoalbuminuria (n = 2) demonstrated diastolic dysfunction (p = 0.013). These 11 patients had lower peak ▪o2 values (p = 0.001) and higher daily UAE (p = 0.028). An inverse linear relationship was found between peak ▪o2 and log10 daily UAE (r = − 0.57, r2 = 0.29, p < 0.001).
Abnormalities reflecting reduced oxygen transport and impaired gas exchange efficiency were found during exercise, and were especially profound in patients with microalbuminuria. These changes could be secondary to pulmonary microangiopathy and myocardial interstitial changes. Increases in capillary permeability to proteins may take place in the myocardium as they do in the kidneys, and contribute to impaired myocardial distensibility and hence diastolic dysfunction.</abstract><cop>Northbrook, IL</cop><pub>Elsevier Inc</pub><pmid>15078737</pmid><doi>10.1378/chest.125.4.1292</doi><tpages>7</tpages></addata></record> |
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| subjects | Albuminuria - etiology Anaerobic threshold Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Angina pectoris Biological and medical sciences Carbon dioxide Cardiology. Vascular system Cardiovascular disease Diabetes Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - physiopathology Diabetes Mellitus, Type 2 - urine Diabetes. Impaired glucose tolerance Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Exercise Female gas exchange Heart rate Hemoglobin Hospitals Humans Male Medical sciences microalbuminuria Middle Aged Oxygen Consumption - physiology Physical fitness Pneumology Pulmonary Gas Exchange - physiology Recruitment Risk factors Spirometry type 2 diabetes Variance analysis |
| title | Altered Exercise Gas Exchange as Related to Microalbuminuria in Type 2 Diabetic Patients |
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