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Updated: Dec 10, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Exercise E/e' Is a Determinant of Exercise Capacity and Adverse Cardiovascular Outcomes in Chronic Kidney Disease
Gary C H Gan1, Krishna K Kadappu2, Aditya Bhat3
1Department of Cardiology Blacktown Hospital, Sydney, New South Wales, Australia; Department of Cardiology Westmead Hospital, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia.
Insights
Exercise E/e
Area of Science:
- Cardiology
- Nephrology
- Echocardiography
Background:
- Patients with chronic kidney disease (CKD) often experience diastolic dysfunction, reduced physical fitness, and increased cardiovascular disease (CVD) risk.
- Assessing cardiac function and exercise capacity is crucial for managing CVD risk in CKD patients.
Purpose of the Study:
- To investigate the relationship between exercise E/e' ratio and exercise capacity in patients with stage 3 and 4 CKD.
- To determine the prognostic value of exercise E/e' for cardiovascular outcomes in this population.
Main Methods:
- A cohort of 156 patients with stage 3-4 CKD and 156 matched controls underwent resting and exercise stress echocardiography.
- Exercise E/e' was measured, and exercise capacity was assessed using metabolic equivalents (METs). Reduced capacity was defined as METs ≤7.
- Patients were followed for 5 years for major adverse cardiovascular events (MACE) and cardiovascular death.
Main Results:
- CKD patients exhibited higher left ventricular mass, larger left atrial volumes, and elevated resting and exercise E/e' compared to controls.
- CKD patients achieved significantly lower exercise METs, with more individuals classified as having reduced exercise capacity (METs ≤7).
- Exercise E/e' emerged as the strongest predictor of reduced exercise capacity (AUC: 0.89). A raised exercise E/e' (>13) independently predicted cardiovascular death and MACE.
Conclusions:
- The E/e' ratio, particularly during exercise, is a significant predictor of exercise capacity in CKD patients.
- Reduced exercise capacity in CKD is likely linked to diastolic dysfunction.
- Elevated exercise E/e' serves as an independent prognostic marker for adverse cardiovascular events in CKD.
Objectives:
This study sought to assess the relationship between E/e' and exercise capacity in patients with chronic kidney disease (CKD) and evaluate its prognostic role.
Background:
Patients with CKD have diastolic dysfunction, reduced physical fitness, and elevated risk of cardiovascular disease.
Methods:
Patients with stage 3 and 4 CKD without previous cardiac disease underwent resting and exercise stress echocardiograms with assessment of exercise E/e'. Patients were compared to age-, sex-, and risk factor-matched control individuals and were followed annually for 5 years for cardiovascular death and major adverse cardiovascular event(s) (MACE). Exercise capacity was assessed as metabolic equivalents (METs), with reduced exercise capacity defined as METs of ≤7. Raised exercise E/e' was defined as >13.
Results:
A total of 156 patients with CKD (age 62.8 ± 10.6 years; male: 62%) were compared to 156 matched control individuals. Patients with CKD were more likely to be anemic (p < 0.01) and had increased left ventricular mass (p < 0.01), larger left atrial volumes (p < 0.01), and higher resting (p < 0.01) and exercise E/e' (p < 0.01). Patients with CKD achieved lower exercise METs (p < 0.01), and more patients with CKD had METs of ≤7 (p < 0.01). Receiver-operating characteristic curves showed exercise E/e' (area under the curve [AUC]: 0.89; 95% CI: 0.84 to 0.95; p < 0.01) as the strongest predictor of reduced exercise capacity in patients with CKD. Over a follow-up period of 41.4 months, a raised exercise E/e' of >13 was an independent predictor of cardiovascular death and MACE on unadjusted and adjusted hazard models.
Conclusion:
E/e' is a strong predictor of exercise capacity and METs achieved by patients with CKD. Exercise capacity was reduced in patients with CKD, presumably consequent to diastolic dysfunction. Elevated exercise E/e' in patients with CKD is an independent predictor of cardiovascular death and MACE.
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