Cardiorespiratory fitness in kidney transplant recipients compared to patients with kidney failure: a systematic review and meta‐analysis

Summary Patients with kidney failure often present with reduced cardiovascular functional reserve and exercise tolerance. Previous studies on cardiorespiratory fitness examined with cardiopulmonary exercise testing (CPET) in kidney transplant recipients (KTR) had variable results. This is a systemat...

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Published in:Transplant international 2021-10, Vol.34 (10), p.1801-1811
Main Authors: Theodorakopoulou, Marieta P., Boutou, Afroditi K., Pella, Eva, Alexandrou, Maria‐Eleni, Patoulias, Dimitrios, Kassimatis, Efstratios, Dipla, Konstantina, Papagianni, Aikaterini, Sarafidis, Pantelis A.
Format: Article
Language:English
Subjects:
cardiopulmonary exercise testing
Cardiorespiratory fitness
Dialysis
exercise capacity
Failure analysis
Hemodialysis
Immunological tolerance
kidney failure
Kidney transplantation
Kidney transplants
Meta-analysis
Oxygen consumption
Peritoneal dialysis
Peritoneum
Physical fitness
Renal failure
Subgroups
Systematic review
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Summary:Summary Patients with kidney failure often present with reduced cardiovascular functional reserve and exercise tolerance. Previous studies on cardiorespiratory fitness examined with cardiopulmonary exercise testing (CPET) in kidney transplant recipients (KTR) had variable results. This is a systematic review and meta‐analysis of studies examining cardiovascular functional reserve with CPET in KTR in comparison with patients with kidney failure (CKD‐Stage‐5 before dialysis, hemodialysis or peritoneal dialysis), as well as before and after kidney transplantation. Literature search involved PubMed, Web‐of‐Science and Scopus databases, manual search of article references and grey literature. From a total of 4,944 identified records, eight studies (with 461 participants) were included in quantitative analysis for the primary question. Across these studies, KTR had significantly higher oxygen consumption at peak/max exercise (VO2peak/VO2max) compared to patients with kidney failure (SMD = 0.70, 95% CI [0.31, 1.10], I2 = 70%, P = 0.002). In subgroup analyses, similar differences were evident among seven studies comparing KTR and hemodialysis patients (SMD = 0.64, 95% CI [0.16, 1.12], I2 = 65%, P = 0.009) and two studies comparing KTR with peritoneal dialysis subjects (SMD = 1.14, 95% CI [0.19, 2.09], I2 = 50%, P = 0.16). Across four studies with relevant data, oxygen consumption during peak/max exercise showed significant improvement after kidney transplantation compared to pretransplantation values (WMD = 2.43, 95% CI [0.01, 4.85], I2 = 68%, P = 0.02). In conclusion, KTR exhibit significantly higher cardiovascular functional reserve during CPET compared to patients with kidney failure. Cardiovascular reserve is significantly improved after kidney transplantation in relation to presurgery levels. Patients with kidney failure often present with reduced cardiovascular functional reserve and exercise tolerance. The present systematic review and meta‐analysis suggests that kidney transplant recipients exhibit significantly higher cardiovascular functional reserve during CPET compared to patients with kidney failure, as cardiovascular reserve is shown to be significantly improved after kidney transplantation in relation to presurgery levels.
ISSN:0934-0874
1432-2277
DOI:10.1111/tri.13961