Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2025
A simple test of walking speed during transplant preassessment predicts positive cardiac investigations and mortality.
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Satish Pranav, Smith Rebecca, Alasadi Ala, Frackiewicz Ewa, Fernando Raymond, Jeetley Paramjit, Wittenberg Marc, Motallebzadeh Reza, Jones Gareth
Аннотация
BACKGROUND: Prior to renal transplant listing, cardiovascular screening is performed to stratify the risk of cardiovascular disease (CVD). However, the added benefit of screening patients with formal cardiac testing remains unclear. In our centre, patients being assessed for transplant underwent a timed assessment to walk 130 m to quantify exercise tolerance. This study examines the efficacy of this test to predict cardiovascular screening results and post-transplantation outcomes.
METHODS: We retrospectively analysed 995 patients in a single centre who underwent pretransplant assessment, which included the walk test time (WTT) in addition to established cardiac screening protocols. Patients were divided into quartiles of the time taken to perform the walk test. We calculated the test's predictive value using sensitivity analysis. Significant covariates in predicting death and cardiovascular events were identified. Kaplan-Meier analysis indicated survival times between quartiles.
RESULTS: The fastest quartile (Q1) of WTT were younger, had lower body mass index, were less frail and had lower rates of CVD and diabetes at baseline. Q1 had lower rates of cardiac events and mortality compared with the slowest quartile of WTT (Q4) (1.62% versus 10.6% in Q4; P < .001). Q1 had lower rates of abnormal cardiac stress testing (13.8% Q1 versus 22.8% Q4; P = .052) and higher rates of activation for transplantation (90.6% Q1 versus 55.3% Q4; P < 0.001). Transplant rates were similar between quartiles (69.7% Q1 versus 71.2% Q4; P = .767). Walk time was a significant predictor of cardiac events [hazard ratio (HR) 1.011, P = .048] but not of mortality (HR 1.003, P = .446). Sensitivity analysis showed a high negative predictive value (86.2%) for WTT as a predictor of stress test results.
CONCLUSIONS: We present a rapid, non-invasive method of assessing cardiorespiratory function before renal transplantation. Current protocols for pretransplant assessment may overinvestigate patients with low cardiovascular risk, thereby delaying activation and subsequent transplant. Frailer, older patients with CVD and diabetes may benefit from focussed cardiac screening.
METHODS: We retrospectively analysed 995 patients in a single centre who underwent pretransplant assessment, which included the walk test time (WTT) in addition to established cardiac screening protocols. Patients were divided into quartiles of the time taken to perform the walk test. We calculated the test's predictive value using sensitivity analysis. Significant covariates in predicting death and cardiovascular events were identified. Kaplan-Meier analysis indicated survival times between quartiles.
RESULTS: The fastest quartile (Q1) of WTT were younger, had lower body mass index, were less frail and had lower rates of CVD and diabetes at baseline. Q1 had lower rates of cardiac events and mortality compared with the slowest quartile of WTT (Q4) (1.62% versus 10.6% in Q4; P < .001). Q1 had lower rates of abnormal cardiac stress testing (13.8% Q1 versus 22.8% Q4; P = .052) and higher rates of activation for transplantation (90.6% Q1 versus 55.3% Q4; P < 0.001). Transplant rates were similar between quartiles (69.7% Q1 versus 71.2% Q4; P = .767). Walk time was a significant predictor of cardiac events [hazard ratio (HR) 1.011, P = .048] but not of mortality (HR 1.003, P = .446). Sensitivity analysis showed a high negative predictive value (86.2%) for WTT as a predictor of stress test results.
CONCLUSIONS: We present a rapid, non-invasive method of assessing cardiorespiratory function before renal transplantation. Current protocols for pretransplant assessment may overinvestigate patients with low cardiovascular risk, thereby delaying activation and subsequent transplant. Frailer, older patients with CVD and diabetes may benefit from focussed cardiac screening.