Prognostic Value of Exercise Capacity in Kidney Transplant Candidates

Area of Science:

• Cardiology
• Nephrology
• Transplantation Medicine

Background:

• Exercise stress testing is a feasible alternative to pharmacologic methods for cardiovascular assessment in kidney transplant candidates.
• Exercise capacity assessed during stress testing may predict long-term cardiovascular outcomes in pre-transplant recipients.

Purpose of the Study:

• To evaluate the prognostic value of exercise capacity on long-term cardiovascular outcomes in kidney transplant candidates.

Main Methods:

• Retrospective evaluation of 898 kidney transplant candidates undergoing exercise stress echocardiography (2013-2020).
• Exercise capacity measured by age- and sex-predicted metabolic equivalents (METs).
• Primary outcome: major adverse cardiovascular events (cardiac death, myocardial infarction, stroke). Cox proportional hazard modeling used.

Main Results:

• 48% of patients achieved predicted METs.
• 10% experienced major adverse cardiovascular events; 58% underwent transplantation.
• Achieving predicted METs was independently associated with reduced major adverse cardiovascular events (HR 0.49).
• Transplantation was also associated with reduced events (HR 0.52).
• Patients achieving predicted METs had favorable outcomes, independent of and similar in magnitude to transplantation.

Conclusions:

• Achieving predicted METs on pre-transplant exercise stress echocardiography indicates an excellent prognosis.
• This prognostic benefit is independent of and comparable to that of subsequent kidney transplantation.
• Future research should explore the benefits of exercise training interventions in this patient population.