Background Patients with chronic kidney failure (CKF) experience impaired functional cardiovascular reserve with reduced oxygen consumption at peak exercise (V o2peak ). No studies have examined ...whether this is related to impaired cardiovascular compliance as a consequence of loss of adaptive structural alterations, resulting from chronic uremia or hypertension. Study Design Prospective matched-cohort study. Setting & Participants We assessed CKF in parallel with patients with essential hypertension but without cardiovascular disease. Patients with CKF were either scheduled for kidney transplantation or transplant waitlisted. 80 patients with CKF and 80 with essential hypertension matched in age, sex, and body mass index were evaluated. 61 patients with CKF (76.3%) were dialysis dependent. Predictor CKF versus essential hypertension without cardiovascular disease. Measurements & Outcomes V o2peak was measured during maximal exercise testing. 2-dimensional echocardiography and arterial applanation tonometry were performed prior to exercise testing. To evaluate for the difference in V o2peak between study groups, statistically significant predictors of V o2peak in multiple regression models were additionally assessed by fitting models comprising the interaction term of patient group with the predictor variable of interest. Results V o2peak was significantly lower in patients with CKF than those with essential hypertension (18.8 vs 24.5 mL/min·kg; P < 0.001). Independent predictors of V o2peak for CKF included left ventricular (LV) filling pressure (E/mean e′; unstandardized regression coefficient: change in V o2peak in mL/min·kg per 1-unit change of variable = −5.1) and pulse wave velocity (−4.0); in essential hypertension, these were LV mass index (0.2), LV end-diastolic volume index (0.4), peak heart rate (0.2), and pulse wave velocity (−8.8). The interaction effect of V o2peak between patient groups with LV mass index ( P < 0.001), LV end-diastolic volume index ( P < 0.001), and peak heart rate ( P < 0.01) were significantly stronger in the hypertension group, whereby higher values led to greater V o2peak. Limitations Skeletal muscle strength was not assessed. Conclusion This study suggests that maladaptive LV changes, as well as blunted chronotropic response, are important mechanistic factors resulting in reduced cardiovascular reserve in patients with CKF, beyond predominantly vascular changes associated with hypertension.
Abstract Peroneal tendon pathology is rare, but is probably underestimated because it is frequently undiagnosed. It should always be in the differential diagnosis of lateral ankle pain. Surgical ...treatment of peroneal tendinopathy is indicated after failure of conservative measures. The aim of this retrospective study is to evaluate the medium-term clinical results of 17 patients operated for peroneal tendinopathy without tendon subluxation. A series of 17 patients composed of 7 women and 10 men with a mean age of 53.6 ± 4.6 (range 45 to 60) years were reviewed. The mean preoperative Kitaoka score was 46.7 ± 17.1 (range 25 to 69) points. All patients had radiological evaluation, which demonstrated hindfoot varus in 6 of the 17. Surgical interventions comprised synovectomy, debridement, suture-tubularization, fibrous resection, or tenodesis depending on the preoperative findings and also a valgus osteotomy (Dwyer) in 6 cases and ankle ligament reconstruction (modified Blanchet) in 1 case. All patients were reviewed clinically with a mean follow-up of 4.3 ± 3.8 years (range 16 months to 14 years). Average time to return to sport was 8.5 ± 10.4 months (range 3 months to 3 years). The mean time to return to work was 2.5 ± 1.9 (range 0 to 6) months. The mean postoperative Kitaoka score was 90.1 ± 11 (range 64 to 100) points with a statistically significant improvement to the preoperative score ( p < .0001). Sixteen patients were satisfied or very satisfied with their treatment (94.1%). Surgical treatment of peroneal tendinopathy after failed conservative treatment leads to significantly improved function. It is a simple treatment to undertake, which gives a good outcome for both the patient and surgeon.
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