Abstract: SA-PO146

Exercise Capacity Predicts Mortality and Morbidity in Patients across the CKD Trajectory

Session Information

Category: Nutrition, Inflammation, and Metabolism

  • 1401 Nutrition, Inflammation, Metabolism

Authors

  • Greenwood, Sharlene A., King's College Hospital, London, United Kingdom
  • O'Connor, Ellen M, King's College Hospital, London, United Kingdom
  • MacLaughlin, Helen L., King's College Hospital, London, United Kingdom
  • Macdougall, Iain C., King's College Hospital, London, United Kingdom
Background

Exercise capacity is reduced in patients with chronic kidney disease (CKD). Low exercise capacity has been shown to be an independent predictor of mortality in patients with end-stage renal disease. We analysed the value of exercise capacity, characterised as the incremental shuttle walk test (ISWT) for predicting mortality and morbidity in a cohort of 438 patients (male 54%) from across the CKD trajectory (124 haemodialysis patients, 126 kidney transplant recipients, 31 peritoneal dialysis patients, 157 non-dialysis patients) over a 12-year period from 2005 to 2017 (median follow-up of 34 months).

Methods

Survival status was determined for 438 patients with CKD who were referred to an outpatient renal rehabilitation programme for which the ISWT and other clinical data had been determined. Chi-square and Kaplan-Meier survival analyses were performed. Risk of mortality was investigated independent of modality, BMI, diabetic status, age, gender, ethnicity, and smoking status using Cox proportional hazards model.

Results

There were a total of 108 combined events (death, cerebrovascular accident and hospitalisation for chronic heart failure) during the follow-up period. ISWT (>270m; p<0.0001 by Kaplan-Meier) was a strong predictor of mortality and morbidity. Determinants of functional ability, Sit to Stand 60 test (>18 complete transfers; p<0.0001 by Kaplan-Meier), Timed Up and Go 3m test (>8.05s; p=0.0001 by Kaplan-Meier), the Duke's Activity Status Index (>23.45; 0.003 by Kaplan-Meier) were also strong predictors of survival. On multivariate analysis, ISWT contributed significantly to the minimal explanatory model relating clinical variables to mortality and morbidity (overall x2 37.4, p=0.001). Patients who were able to walk >270m had a 2.3-fold (Hazard Ratio = 2.3; 95% confidence interval: 1.1 to 4.7) independent greater risk of a combined event (P = 0.02).

Conclusion

Exercise capacity is strongly predictive of mortality and morbidity in patients across the CKD trajectory. Exercise training interventions to improve clinical outcome in patients with CKD should be explored.