Cardiorespiratory fitness (peak oxygen uptake): Safe and effective measure for cardiovascular screening before kidney transplant

Harini A. Chakkera, Siddhartha Angadi, Raymond L. Heilman, Bruce Kaplan, Robert L. Scott, Harini Bollempalli, Stephen S. Cha, Hasan A. Khamash, Janna L. Huskey, Girish K. Mour, Sumi Sukumaran Nair, Andrew L. Singer, Kunam S. Reddy, Amit K. Mathur, Adyr A. Moss, Winston R. Hewitt, Ibrahim Qaqish, Senaida Behmen, Mira T. Keddis, Samuel Unzek & 1 others D. Eric Steidley

Research output: Contribution to journalArticle

Abstract

Background--Significant heterogeneity exists in practice patterns and algorithms used for cardiac screening before kidney transplant. Cardiorespiratory fitness, as measured by peak oxygen uptake (VO2peak), is an established validated predictor of future cardiovascular morbidity and mortality in both healthy and diseased populations. The literature supports its use among asymptomatic patients in abrogating the need for further cardiac testing. Methods and Results--We outlined a pre-renal transplant screening algorithm to incorporate VO2peak testing among a population of asymptomatic high-risk patients (with diabetes mellitus and/or > 50 years of age). Only those with VO2peak < 17 mL/kg per minute (equivalent to < 5 metabolic equivalents) underwent further noninvasive cardiac screening tests. We conducted a retrospective study of the a priori dichotomization of the VO2peak < 17 versus ≥17 mL/kg per minute to determine negative and positive predictive value of future cardiac events and all-cause mortality. We report a high (> 90%) negative predictive value, indicating that VO2peak ≥17 mL/kg per minute is effective to rule out future cardiac events and all-cause mortality. However, lower VO2peak had low positive predictive value and should not be used as a reliable metric to predict future cardiac events and/or mortality. In addition, a simple mathematical calculation documented a cost savings of ≈$272 600 in the cardiac screening among our study cohort of 637 patients undergoing evaluation for kidney and/or pancreas transplant. Conclusions--We conclude that incorporating an objective measure of cardiorespiratory fitness with VO2peak is safe and allows for a cost savings in the cardiovascular screening protocol among higher-risk phenotype (with diabetes mellitus and > 50 years of age) being evaluated for kidney transplant.

Original languageEnglish (US)
Article numbere008662
JournalJournal of the American Heart Association
Volume7
Issue number11
DOIs
StatePublished - Jun 1 2018

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Oxygen
Transplants
Kidney
Cost Savings
Mortality
Diabetes Mellitus
Population
Pancreas
Cohort Studies
Morbidity
Phenotype
Cardiorespiratory Fitness

Keywords

  • Function
  • Ischemic heart disease
  • Kidney
  • Risk assessment
  • Risk stratification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiorespiratory fitness (peak oxygen uptake) : Safe and effective measure for cardiovascular screening before kidney transplant. / Chakkera, Harini A.; Angadi, Siddhartha; Heilman, Raymond L.; Kaplan, Bruce; Scott, Robert L.; Bollempalli, Harini; Cha, Stephen S.; Khamash, Hasan A.; Huskey, Janna L.; Mour, Girish K.; Nair, Sumi Sukumaran; Singer, Andrew L.; Reddy, Kunam S.; Mathur, Amit K.; Moss, Adyr A.; Hewitt, Winston R.; Qaqish, Ibrahim; Behmen, Senaida; Keddis, Mira T.; Unzek, Samuel; Steidley, D. Eric.

In: Journal of the American Heart Association, Vol. 7, No. 11, e008662, 01.06.2018.

Research output: Contribution to journalArticle

Chakkera, HA, Angadi, S, Heilman, RL, Kaplan, B, Scott, RL, Bollempalli, H, Cha, SS, Khamash, HA, Huskey, JL, Mour, GK, Nair, SS, Singer, AL, Reddy, KS, Mathur, AK, Moss, AA, Hewitt, WR, Qaqish, I, Behmen, S, Keddis, MT, Unzek, S & Steidley, DE 2018, 'Cardiorespiratory fitness (peak oxygen uptake): Safe and effective measure for cardiovascular screening before kidney transplant' Journal of the American Heart Association, vol. 7, no. 11, e008662. https://doi.org/10.1161/JAHA.118.008662
Chakkera, Harini A. ; Angadi, Siddhartha ; Heilman, Raymond L. ; Kaplan, Bruce ; Scott, Robert L. ; Bollempalli, Harini ; Cha, Stephen S. ; Khamash, Hasan A. ; Huskey, Janna L. ; Mour, Girish K. ; Nair, Sumi Sukumaran ; Singer, Andrew L. ; Reddy, Kunam S. ; Mathur, Amit K. ; Moss, Adyr A. ; Hewitt, Winston R. ; Qaqish, Ibrahim ; Behmen, Senaida ; Keddis, Mira T. ; Unzek, Samuel ; Steidley, D. Eric. / Cardiorespiratory fitness (peak oxygen uptake) : Safe and effective measure for cardiovascular screening before kidney transplant. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 11.
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abstract = "Background--Significant heterogeneity exists in practice patterns and algorithms used for cardiac screening before kidney transplant. Cardiorespiratory fitness, as measured by peak oxygen uptake (VO2peak), is an established validated predictor of future cardiovascular morbidity and mortality in both healthy and diseased populations. The literature supports its use among asymptomatic patients in abrogating the need for further cardiac testing. Methods and Results--We outlined a pre-renal transplant screening algorithm to incorporate VO2peak testing among a population of asymptomatic high-risk patients (with diabetes mellitus and/or > 50 years of age). Only those with VO2peak < 17 mL/kg per minute (equivalent to < 5 metabolic equivalents) underwent further noninvasive cardiac screening tests. We conducted a retrospective study of the a priori dichotomization of the VO2peak < 17 versus ≥17 mL/kg per minute to determine negative and positive predictive value of future cardiac events and all-cause mortality. We report a high (> 90{\%}) negative predictive value, indicating that VO2peak ≥17 mL/kg per minute is effective to rule out future cardiac events and all-cause mortality. However, lower VO2peak had low positive predictive value and should not be used as a reliable metric to predict future cardiac events and/or mortality. In addition, a simple mathematical calculation documented a cost savings of ≈$272 600 in the cardiac screening among our study cohort of 637 patients undergoing evaluation for kidney and/or pancreas transplant. Conclusions--We conclude that incorporating an objective measure of cardiorespiratory fitness with VO2peak is safe and allows for a cost savings in the cardiovascular screening protocol among higher-risk phenotype (with diabetes mellitus and > 50 years of age) being evaluated for kidney transplant.",
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T1 - Cardiorespiratory fitness (peak oxygen uptake)

T2 - Safe and effective measure for cardiovascular screening before kidney transplant

AU - Chakkera, Harini A.

AU - Angadi, Siddhartha

AU - Heilman, Raymond L.

AU - Kaplan, Bruce

AU - Scott, Robert L.

AU - Bollempalli, Harini

AU - Cha, Stephen S.

AU - Khamash, Hasan A.

AU - Huskey, Janna L.

AU - Mour, Girish K.

AU - Nair, Sumi Sukumaran

AU - Singer, Andrew L.

AU - Reddy, Kunam S.

AU - Mathur, Amit K.

AU - Moss, Adyr A.

AU - Hewitt, Winston R.

AU - Qaqish, Ibrahim

AU - Behmen, Senaida

AU - Keddis, Mira T.

AU - Unzek, Samuel

AU - Steidley, D. Eric

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background--Significant heterogeneity exists in practice patterns and algorithms used for cardiac screening before kidney transplant. Cardiorespiratory fitness, as measured by peak oxygen uptake (VO2peak), is an established validated predictor of future cardiovascular morbidity and mortality in both healthy and diseased populations. The literature supports its use among asymptomatic patients in abrogating the need for further cardiac testing. Methods and Results--We outlined a pre-renal transplant screening algorithm to incorporate VO2peak testing among a population of asymptomatic high-risk patients (with diabetes mellitus and/or > 50 years of age). Only those with VO2peak < 17 mL/kg per minute (equivalent to < 5 metabolic equivalents) underwent further noninvasive cardiac screening tests. We conducted a retrospective study of the a priori dichotomization of the VO2peak < 17 versus ≥17 mL/kg per minute to determine negative and positive predictive value of future cardiac events and all-cause mortality. We report a high (> 90%) negative predictive value, indicating that VO2peak ≥17 mL/kg per minute is effective to rule out future cardiac events and all-cause mortality. However, lower VO2peak had low positive predictive value and should not be used as a reliable metric to predict future cardiac events and/or mortality. In addition, a simple mathematical calculation documented a cost savings of ≈$272 600 in the cardiac screening among our study cohort of 637 patients undergoing evaluation for kidney and/or pancreas transplant. Conclusions--We conclude that incorporating an objective measure of cardiorespiratory fitness with VO2peak is safe and allows for a cost savings in the cardiovascular screening protocol among higher-risk phenotype (with diabetes mellitus and > 50 years of age) being evaluated for kidney transplant.

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KW - Ischemic heart disease

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KW - Risk assessment

KW - Risk stratification

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