Cardiorespiratory fitness assessed by cardiopulmonary exercise testing between different stages of pre‐dialysis chronic kidney disease: A systematic review and meta‐analysis
ABSTRACT Aim The 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...
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| Veröffentlicht in: | Nephrology (Carlton, Vic.) Vic.), 2021-12, Vol.26 (12), p.972-980 |
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| creator | Alexandrou, Maria‐Eleni Theodorakopoulou, Marieta Boutou, Afroditi Pella, Eva Boulmpou, Aristi Papadopoulos, Christodoulos E. Zafeiridis, Andreas Papagianni, Aikaterini Sarafidis, Pantelis |
| description | ABSTRACT
Aim
The 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.
Methods
We 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 (VO2peak) 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 books of relevant meetings. Quality assessment was undertaken with Newcastle‐Ottawa‐Scale.
Results
From 4944 records initially retrieved, six studies with 512 participants fulfilling our inclusion criteria were included in the primary meta‐analysis. Peak oxygen uptake (VO2peak) 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 (VO2VT) was higher in Stages 2–3a compared with those in 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.
Conclusion
VO2peak and VO2VT assessed with CPET are significantly lower in patients in CKD Stages 3b–5 compared with Stages 2–3a. Reduced cardiorespiratory fitness may be another factor contributing to cardiovascular risk increase with advancing CKD.
SUMMARY AT A GLANCE
Exercise (cardiorespiratory) capacity is an often overlooked aspect of health in people with chronic kidney disease. Among people with CKD, markers of cardiorespiratory capacity are significantly lower in advanced CKD compared with earlier stages of CKD. |
| doi_str_mv | 10.1111/nep.13951 |
| format | Article |
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Aim
The 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.
Methods
We 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 (VO2peak) 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 books of relevant meetings. Quality assessment was undertaken with Newcastle‐Ottawa‐Scale.
Results
From 4944 records initially retrieved, six studies with 512 participants fulfilling our inclusion criteria were included in the primary meta‐analysis. Peak oxygen uptake (VO2peak) 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 (VO2VT) was higher in Stages 2–3a compared with those in 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.
Conclusion
VO2peak and VO2VT assessed with CPET are significantly lower in patients in CKD Stages 3b–5 compared with Stages 2–3a. Reduced cardiorespiratory fitness may be another factor contributing to cardiovascular risk increase with advancing CKD.
SUMMARY AT A GLANCE
Exercise (cardiorespiratory) capacity is an often overlooked aspect of health in people with chronic kidney disease. Among people with CKD, markers of cardiorespiratory capacity are significantly lower in advanced CKD compared with earlier stages of CKD.</description><identifier>ISSN: 1320-5358</identifier><identifier>EISSN: 1440-1797</identifier><identifier>DOI: 10.1111/nep.13951</identifier><identifier>PMID: 34288260</identifier><language>eng</language><publisher>Melbourne: John Wiley & Sons Australia, Ltd</publisher><subject>cardiopulmonary exercise testing ; Cardiorespiratory fitness ; Cardiorespiratory Fitness - physiology ; Cardiovascular diseases ; chronic kidney disease ; Dialysis ; Exercise Test ; Exercise Therapy - methods ; exercise tolerance ; Hemodialysis ; Humans ; Intolerance ; Kidney diseases ; Maximum oxygen consumption ; Meta-analysis ; Oxygen consumption ; peak oxygen uptake ; Physical fitness ; Quality control ; Renal function ; Renal Insufficiency, Chronic - physiopathology ; Renal Insufficiency, Chronic - rehabilitation ; Risk factors ; Sensitivity analysis ; Systematic review</subject><ispartof>Nephrology (Carlton, Vic.), 2021-12, Vol.26 (12), p.972-980</ispartof><rights>2021 Asian Pacific Society of Nephrology.</rights><rights>2021 Asian Pacific Society of Nephrology</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3531-db28275460850eeee98f5980ef169d4c5ba3feb43593c8bdf7d25da2af550dbf3</citedby><cites>FETCH-LOGICAL-c3531-db28275460850eeee98f5980ef169d4c5ba3feb43593c8bdf7d25da2af550dbf3</cites><orcidid>0000-0003-3526-261X ; 0000-0001-8383-2184</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fnep.13951$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fnep.13951$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34288260$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Alexandrou, Maria‐Eleni</creatorcontrib><creatorcontrib>Theodorakopoulou, Marieta</creatorcontrib><creatorcontrib>Boutou, Afroditi</creatorcontrib><creatorcontrib>Pella, Eva</creatorcontrib><creatorcontrib>Boulmpou, Aristi</creatorcontrib><creatorcontrib>Papadopoulos, Christodoulos E.</creatorcontrib><creatorcontrib>Zafeiridis, Andreas</creatorcontrib><creatorcontrib>Papagianni, Aikaterini</creatorcontrib><creatorcontrib>Sarafidis, Pantelis</creatorcontrib><title>Cardiorespiratory fitness assessed by cardiopulmonary exercise testing between different stages of pre‐dialysis chronic kidney disease: A systematic review and meta‐analysis</title><title>Nephrology (Carlton, Vic.)</title><addtitle>Nephrology (Carlton)</addtitle><description>ABSTRACT
Aim
The 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.
Methods
We 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 (VO2peak) 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 books of relevant meetings. Quality assessment was undertaken with Newcastle‐Ottawa‐Scale.
Results
From 4944 records initially retrieved, six studies with 512 participants fulfilling our inclusion criteria were included in the primary meta‐analysis. Peak oxygen uptake (VO2peak) 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 (VO2VT) was higher in Stages 2–3a compared with those in 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.
Conclusion
VO2peak and VO2VT assessed with CPET are significantly lower in patients in CKD Stages 3b–5 compared with Stages 2–3a. Reduced cardiorespiratory fitness may be another factor contributing to cardiovascular risk increase with advancing CKD.
SUMMARY AT A GLANCE
Exercise (cardiorespiratory) capacity is an often overlooked aspect of health in people with chronic kidney disease. Among people with CKD, markers of cardiorespiratory capacity are significantly lower in advanced CKD compared with earlier stages of CKD.</description><subject>cardiopulmonary exercise testing</subject><subject>Cardiorespiratory fitness</subject><subject>Cardiorespiratory Fitness - physiology</subject><subject>Cardiovascular diseases</subject><subject>chronic kidney disease</subject><subject>Dialysis</subject><subject>Exercise Test</subject><subject>Exercise Therapy - methods</subject><subject>exercise tolerance</subject><subject>Hemodialysis</subject><subject>Humans</subject><subject>Intolerance</subject><subject>Kidney diseases</subject><subject>Maximum oxygen consumption</subject><subject>Meta-analysis</subject><subject>Oxygen consumption</subject><subject>peak oxygen uptake</subject><subject>Physical fitness</subject><subject>Quality control</subject><subject>Renal function</subject><subject>Renal Insufficiency, Chronic - physiopathology</subject><subject>Renal Insufficiency, Chronic - rehabilitation</subject><subject>Risk factors</subject><subject>Sensitivity analysis</subject><subject>Systematic review</subject><issn>1320-5358</issn><issn>1440-1797</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1u1TAQhSMEoj-w4AWQJTZ0kdY_8Y3DrroqtFJFWcA6cuxxcUmc4HG4ZMcj8Cq8Ek-C2xQWlZjNjDTfObLnFMULRo9ZrpMA0zETjWSPin1WVbRkdVM_zrPgtJRCqr3iAPGGUlbzDXta7ImKK8U3dL_4tdXR-jECTj7qNMaFOJ8CIBKNmBtY0i3E3FHT3A9j0JmB7xCNRyAJMPlwTTpIO4BArHcOIoREMOlrQDI6MkX4_eOn9bpf0CMxn-MYvCFfvA2wZAWCRnhDTgkumGDQKS8jfPOwIzpYMkDSWa_Dqn9WPHG6R3h-3w-LT2_PPm7Py8urdxfb08vSCClYaTuueC2rDVWSQq5GOdkoCo5tGlsZ2WnhoKuEbIRRnXW15dJqrp2U1HZOHBavV98pjl_n_M128Gig73WAccaWSylUPiivM_rqAXozzjG_95ZqKlWJHEimjlbKxBExgmun6Id8zZbR9jbHNufY3uWY2Zf3jnM3gP1H_g0uAycrsPM9LP93at-ffVgt_wCHaK6T</recordid><startdate>202112</startdate><enddate>202112</enddate><creator>Alexandrou, Maria‐Eleni</creator><creator>Theodorakopoulou, Marieta</creator><creator>Boutou, Afroditi</creator><creator>Pella, Eva</creator><creator>Boulmpou, Aristi</creator><creator>Papadopoulos, Christodoulos E.</creator><creator>Zafeiridis, Andreas</creator><creator>Papagianni, Aikaterini</creator><creator>Sarafidis, Pantelis</creator><general>John Wiley & Sons Australia, Ltd</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3526-261X</orcidid><orcidid>https://orcid.org/0000-0001-8383-2184</orcidid></search><sort><creationdate>202112</creationdate><title>Cardiorespiratory fitness assessed by cardiopulmonary exercise testing between different stages of pre‐dialysis chronic kidney disease: A systematic review and meta‐analysis</title><author>Alexandrou, Maria‐Eleni ; Theodorakopoulou, Marieta ; Boutou, Afroditi ; Pella, Eva ; Boulmpou, Aristi ; Papadopoulos, Christodoulos E. ; Zafeiridis, Andreas ; Papagianni, Aikaterini ; Sarafidis, Pantelis</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3531-db28275460850eeee98f5980ef169d4c5ba3feb43593c8bdf7d25da2af550dbf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>cardiopulmonary exercise testing</topic><topic>Cardiorespiratory fitness</topic><topic>Cardiorespiratory Fitness - physiology</topic><topic>Cardiovascular diseases</topic><topic>chronic kidney disease</topic><topic>Dialysis</topic><topic>Exercise Test</topic><topic>Exercise Therapy - methods</topic><topic>exercise tolerance</topic><topic>Hemodialysis</topic><topic>Humans</topic><topic>Intolerance</topic><topic>Kidney diseases</topic><topic>Maximum oxygen consumption</topic><topic>Meta-analysis</topic><topic>Oxygen consumption</topic><topic>peak oxygen uptake</topic><topic>Physical fitness</topic><topic>Quality control</topic><topic>Renal function</topic><topic>Renal Insufficiency, Chronic - physiopathology</topic><topic>Renal Insufficiency, Chronic - rehabilitation</topic><topic>Risk factors</topic><topic>Sensitivity analysis</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Alexandrou, Maria‐Eleni</creatorcontrib><creatorcontrib>Theodorakopoulou, Marieta</creatorcontrib><creatorcontrib>Boutou, Afroditi</creatorcontrib><creatorcontrib>Pella, Eva</creatorcontrib><creatorcontrib>Boulmpou, Aristi</creatorcontrib><creatorcontrib>Papadopoulos, Christodoulos E.</creatorcontrib><creatorcontrib>Zafeiridis, Andreas</creatorcontrib><creatorcontrib>Papagianni, Aikaterini</creatorcontrib><creatorcontrib>Sarafidis, Pantelis</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Nephrology (Carlton, Vic.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alexandrou, Maria‐Eleni</au><au>Theodorakopoulou, Marieta</au><au>Boutou, Afroditi</au><au>Pella, Eva</au><au>Boulmpou, Aristi</au><au>Papadopoulos, Christodoulos E.</au><au>Zafeiridis, Andreas</au><au>Papagianni, Aikaterini</au><au>Sarafidis, Pantelis</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiorespiratory fitness assessed by cardiopulmonary exercise testing between different stages of pre‐dialysis chronic kidney disease: A systematic review and meta‐analysis</atitle><jtitle>Nephrology (Carlton, Vic.)</jtitle><addtitle>Nephrology (Carlton)</addtitle><date>2021-12</date><risdate>2021</risdate><volume>26</volume><issue>12</issue><spage>972</spage><epage>980</epage><pages>972-980</pages><issn>1320-5358</issn><eissn>1440-1797</eissn><abstract>ABSTRACT
Aim
The 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.
Methods
We 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 (VO2peak) 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 books of relevant meetings. Quality assessment was undertaken with Newcastle‐Ottawa‐Scale.
Results
From 4944 records initially retrieved, six studies with 512 participants fulfilling our inclusion criteria were included in the primary meta‐analysis. Peak oxygen uptake (VO2peak) 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 (VO2VT) was higher in Stages 2–3a compared with those in 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.
Conclusion
VO2peak and VO2VT assessed with CPET are significantly lower in patients in CKD Stages 3b–5 compared with Stages 2–3a. Reduced cardiorespiratory fitness may be another factor contributing to cardiovascular risk increase with advancing CKD.
SUMMARY AT A GLANCE
Exercise (cardiorespiratory) capacity is an often overlooked aspect of health in people with chronic kidney disease. Among people with CKD, markers of cardiorespiratory capacity are significantly lower in advanced CKD compared with earlier stages of CKD.</abstract><cop>Melbourne</cop><pub>John Wiley & Sons Australia, Ltd</pub><pmid>34288260</pmid><doi>10.1111/nep.13951</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-3526-261X</orcidid><orcidid>https://orcid.org/0000-0001-8383-2184</orcidid></addata></record> |
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| ispartof | Nephrology (Carlton, Vic.), 2021-12, Vol.26 (12), p.972-980 |
| issn | 1320-5358 1440-1797 |
| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | cardiopulmonary exercise testing Cardiorespiratory fitness Cardiorespiratory Fitness - physiology Cardiovascular diseases chronic kidney disease Dialysis Exercise Test Exercise Therapy - methods exercise tolerance Hemodialysis Humans Intolerance Kidney diseases Maximum oxygen consumption Meta-analysis Oxygen consumption peak oxygen uptake Physical fitness Quality control Renal function Renal Insufficiency, Chronic - physiopathology Renal Insufficiency, Chronic - rehabilitation Risk factors Sensitivity analysis Systematic review |
| title | Cardiorespiratory fitness assessed by cardiopulmonary exercise testing between different stages of pre‐dialysis chronic kidney disease: A systematic review and meta‐analysis |
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