In this randomized, double-blinded crossover study, 12 Stage 3-4 CKD patients (Mean±SEM: Age, 60 ± 5yrs; eGFR, 50.3 ± 4.6ml/min/1.73m) received an acute dose of 12.6 mmol of dietary nitrate in the form of concentrated beetroot juice (BRJ) and a nitrate depleted placebo (PLA). Skeletal muscle mitochondrial oxidative function was assessed using near-infrared spectroscopy. Cardiopulmonary exercise testing was performed on a cycle ergometer, with intensity increased by 25W every 3 minutes until volitional fatigue. Plasma Nitric Oxide (NO) metabolites (NOm; nitrate, nitrite, low molecular weight S-nitrosothiols, and metal bound NO) were determined by gas-phase chemiluminescence. Plasma NOm values were significantly increased following BRJ (BRJ vs. PLA: 1074.4±120.4 uM vs. 28.4±6.6 μM, p<0.001). Total work performed (44.4 ± 10.6 vs 39.6 ± 9.9kJ, p=0.03) and total exercise time (674 ± 85 vs 627 ± 86s, p=0.04) were significantly greater following BRJ. Oxygen consumption at the ventilatory threshold was also improved by BRJ (0.90 ± 0.08 vs. 0.74 ± 0.06L/min, p=0.04). These changes occurred in the absence of improved skeletal muscle mitochondrial oxidative capacity (p=0.52) and VO (p=0.35).
Our findings demonstrate that inorganic nitrate can acutely improve exercise capacity in CKD patients. The effects of chronic nitrate supplementation on CKD related exercise intolerance should be investigated in future studies.
Copyright © 2020. Published by Elsevier Inc.