TY - JOUR
T1 - Prognostic Value of Cardiorespiratory Fitness in Patients with Chronic Kidney Disease
T2 - The FIT (Henry Ford Exercise Testing) Project
AU - Chu, Daniel J.
AU - Ahmed, Amjad M.
AU - Qureshi, Waqas T.
AU - Brawner, Clinton A.
AU - Keteyian, Steven J.
AU - Nasir, Khurram
AU - Blumenthal, Roger S.
AU - Blaha, Michael J.
AU - Ehrman, Jonathan K.
AU - Cainzos-Achirica, Miguel
AU - Patel, Kershaw V.
AU - Al Rifai, Mahmoud
AU - Al-Mallah, Mouaz H.
N1 - Funding Information:
Funding: None.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/1
Y1 - 2022/1
N2 - PURPOSE: We conducted this study to investigate the association of cardiorespiratory fitness and all-cause mortality among patients with chronic kidney disease.METHODS: We studied a retrospective cohort of patients from the Henry Ford Health System who underwent clinically indicated exercise stress testing with baseline cardiorespiratory fitness and estimated glomerular filtration rate measurement. Cardiorespiratory fitness was expressed as metabolic equivalents of task, and kidney function was categorized into stages according to estimated glomerular filtration rate. Multivariable-adjusted Cox proportional hazard models were used to examine the association between metabolic equivalents of task and all-cause mortality among patients with chronic kidney disease stages 3-5. Discrimination of mortality was assessed using receiver operating characteristic curves, while reclassification was evaluated using net reclassification index (NRI).RESULTS: Among 50,121 participants, the mean age was 55 ± 12.6 years; 47.5% were women, 64.5% were white, and 6877 (13.7%) participants had chronic kidney disease stage 3-5. Over a median follow-up of 6.7 years, 6308 participants died (12.6%). Each 1-unit higher metabolic equivalents of task was associated with a significant 15% reduction in all-cause mortality (hazard ratio 0.85; 95% confidence interval [CI], 0.84-0.87). Metabolic equivalents of task improved discriminatory ability of mortality prediction when added to traditional risk factors and estimated glomerular filtration rate (area under the curve 0.7996; 95% CI, 0.789-0.810 vs 0.759; 95% CI, 0.748-0.770, respectively; P < .001). The addition of metabolic equivalents of task to traditional risk factors resulted in significant reclassification (6% for events, 5% for non-events: NRI = 0.13, P < .001).CONCLUSIONS: Cardiorespiratory fitness improves mortality risk prediction among patients with chronic kidney disease. Cardiorespiratory fitness provides incremental prognostic information when added to traditional risk factors and may help guide treatment options among patients with renal dysfunction.
AB - PURPOSE: We conducted this study to investigate the association of cardiorespiratory fitness and all-cause mortality among patients with chronic kidney disease.METHODS: We studied a retrospective cohort of patients from the Henry Ford Health System who underwent clinically indicated exercise stress testing with baseline cardiorespiratory fitness and estimated glomerular filtration rate measurement. Cardiorespiratory fitness was expressed as metabolic equivalents of task, and kidney function was categorized into stages according to estimated glomerular filtration rate. Multivariable-adjusted Cox proportional hazard models were used to examine the association between metabolic equivalents of task and all-cause mortality among patients with chronic kidney disease stages 3-5. Discrimination of mortality was assessed using receiver operating characteristic curves, while reclassification was evaluated using net reclassification index (NRI).RESULTS: Among 50,121 participants, the mean age was 55 ± 12.6 years; 47.5% were women, 64.5% were white, and 6877 (13.7%) participants had chronic kidney disease stage 3-5. Over a median follow-up of 6.7 years, 6308 participants died (12.6%). Each 1-unit higher metabolic equivalents of task was associated with a significant 15% reduction in all-cause mortality (hazard ratio 0.85; 95% confidence interval [CI], 0.84-0.87). Metabolic equivalents of task improved discriminatory ability of mortality prediction when added to traditional risk factors and estimated glomerular filtration rate (area under the curve 0.7996; 95% CI, 0.789-0.810 vs 0.759; 95% CI, 0.748-0.770, respectively; P < .001). The addition of metabolic equivalents of task to traditional risk factors resulted in significant reclassification (6% for events, 5% for non-events: NRI = 0.13, P < .001).CONCLUSIONS: Cardiorespiratory fitness improves mortality risk prediction among patients with chronic kidney disease. Cardiorespiratory fitness provides incremental prognostic information when added to traditional risk factors and may help guide treatment options among patients with renal dysfunction.
KW - Cardiorespiratory fitness
KW - Chronic kidney disease
KW - Cardiorespiratory Fitness
KW - Prognosis
KW - Humans
KW - Middle Aged
KW - Male
KW - Michigan/epidemiology
KW - Renal Insufficiency, Chronic/mortality
KW - Survival Analysis
KW - Adult
KW - Female
KW - Aged
KW - Retrospective Studies
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U2 - 10.1016/j.amjmed.2021.07.042
DO - 10.1016/j.amjmed.2021.07.042
M3 - Article
C2 - 34509447
AN - SCOPUS:85117377811
SN - 0002-9343
VL - 135
SP - 67-75.e1
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 1
ER -