Long term prognostic utility of exercise capacity in renal transplant candidates

Abstract Background Pharmacological stress testing is commonly performed for cardiovascular risk stratification in potential renal transplant candidates due to a perceived inability these patients exercise. We have previously reported that exercise feasible but the prognostic utility of capacity this patient group not known. Purpose This study prospectively evaluated effect on major adverse events (MACE), defined as composite cardiac death, non-fatal myocardial infarction, and stroke, undergoing echocardiography (ESE) pre-transplant assessment. Methods 898 consecutive with chronic kidney disease stage 4/5 who underwent symptom-limited treadmill ESE over 5-year mean follow-up. Exercise was measured by age sex predicted metabolic equivalents (METs). The primary outcome achievement METs first MACE. Cox proportional hazard multivariable modelling used determine MACE predictors transplantation treated time-varying covariate. also secondary analysis using 7 MET threshold. Results There were 106 an annual cumulative 2.4%. During follow-up, 525 (58%) received transplantation. Achievement (48%) (hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.29–0.82, p=0.007) (HR 0.52, CI 0.30–0.91, p=0.02) independently associated reduced Similar results observed threshold achieved 734 (82%) patients. Patients achieving had no difference regardless subsequent 0.78, 0.32–1.92, p=0.59). did receive similar outcomes those achieve 0.97, 0.42–2.25, p=0.95). Conclusions long-term confers excellent prognosis independent Funding Acknowledgement Type funding sources: None.