Exercise capacity in pediatric patients with end-stage renal disease.

Objective: To evaluate the correlation between exercise capacity and hemoglobin in pediatric patients with end-stage renal disease (ESRD) treated with automated peritoneal dialysis (APD) and hemodialysis.

Design: Prospective case-control study and retrospective review.

Setting: Dialysis summer camp and Children's Mercy Hospital exercise laboratory.

Participants: Prospective evaluation conducted with 14 patients (9 males, mean age 14.5 +/- 2.5 years) who received either home APD (5 patients) or in-center hemodialysis (9 patients), and 8 healthy age-matched controls. Retrospective data derived from 10 children (7 males, mean age 12.3 +/- 3.3 years), all of whom received APD.

Intervention: Maximal treadmill evaluation conducted with each patient and control. The hemoglobin value of each patient was also assessed.

Main Outcome Measures: Comparison of the following data generated during treadmill protocol: peak heart rate, blood pressure, oxygen saturation, treadmill time, oxygen consumption (VO2), ventilation (Ve), oxygen consumption at anaerobic threshold (VO2AT), and respiratory exchange ratio.

Results: The hemoglobin value of the current patient group (12.8 +/- 1.6 g/dL) was significantly greater than the previously studied patients (10.5 +/- 1.1 g/dL) (p = 0.001). Treadmill time, VO2, and VO2AT were significantly lower in both groups of dialysis patients compared to the control subjects (p < 0.05). No differences were noted in any of these variables when comparing these two groups of dialysis patients only.

Conclusion: The exercise capacity of pediatric dialysis patients is significantly poorer than that of healthy children, an outcome apparently related to factors other than normalization of the hemoglobin value.