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 UnzekD. 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

    Fingerprint

    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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    TY - JOUR

    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.

    AB - 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.

    KW - Function

    KW - Ischemic heart disease

    KW - Kidney

    KW - Risk assessment

    KW - Risk stratification

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