Cardiorespiratory fitness assessed by cardiopulmonary exercise testing between different stages of pre-dialysis chronic kidney disease: a systematic review and meta-analysis.

Abstract

AIM\nThe burden of several cardiovascular risk factors increases in parallel to renal function decline. Exercise intolerance is common in patients with chronic kidney disease (CKD) and has been associated with increased risk of adverse outcomes. Whether indices of cardiorespiratory capacity deteriorate with advancing CKD stages is unknown.\n\n\nMETHODS\nWe conducted a systematic review and meta-analysis of studies assessing cardiorespiratory capacity in adult patients with pre-dialysis CKD using cardiopulmonary exercise testing (CPET) and reporting data for different stages. Our primary outcome was differences in peak oxygen uptake (VO2 peak) between patients with CKD Stages 2-3a and those with Stages 3b-5(pre-dialysis). Literature search was undertaken in PubMed, Web of Science and Scopus databases, and abstract books of relevant meetings. Quality assessment was undertaken with Newcastle-Ottawa-Scale.\n\n\nRESULTS\nFrom 4944 records initially retrieved, 6 studies with 512 participants fulfilling our inclusion criteria were included in the primary meta-analysis. Peak oxygen uptake (VO2 peak) was significantly higher in patients with CKD Stages 2-3a versus those with Stages 3b-5(pre-dialysis) (weighted-mean-difference, WMD: 2.46, 95%CI[1.15, 3.78]). Oxygen consumption at ventilatory threshold (VO2 VT) was higher in Stages 2-3a compared to those with Stages 3b-5(pre-dialysis) (standardized-mean-difference, SMD: 0.59, 95%CI[0.06, 1.1), while no differences were observed for maximum workload and respiratory-exchange-ratio. A secondary analysis comparing patients with CKD Stages 2-3b and Stages 4-5(pre-dialysis), yielded similar results (WMD: 1.78, 95%CI[1.34, 2.22]). Sensitivity analysis confirmed the robustness of these findings.\n\n\nCONCLUSION\nVO2 peak and VO2 VT assessed with CPET are significantly lower in patients in CKD Stages 3b-5 compared to Stages 2-3a. Reduced cardiorespiratory fitness may be another factor contributing to cardiovascular risk increase with advancing CKD. This article is protected by copyright. All rights reserved.