Cardiorespiratory Fitness and Mortality in Patients With Chronic Kidney Disease: A Prospective Cohort Study

Authors

Xuemei Sui, Department of Exercise Science, University of South Carolina, Columbia, SC, USA. Electronic address: msui@mailbox.sc.edu.
Peter Kokkinos, Veterans Affairs Medical Center, Washington, DC, USA; Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA; Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Charles Faselis, Veterans Affairs Medical Center, Washington, DC, USA.
Immanuel Babu Samuel, Veterans Affairs Medical Center, Washington, DC, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Washington, DC, USA; BRAIN Lab, War Related Illness and Injury Study Center, Washington, DC, USA.
Andreas Pittaras, Veterans Affairs Medical Center, Washington, DC, USA.
Jared Gollie, Veterans Affairs Medical Center, Washington, DC, USA.
Samir Patel, Veterans Affairs Medical Center, Washington, DC, USA.
Carl J. Lavie, John Ochsner Heart and Vascular Institute, New Orleans, LA, USA.
Jiajia Zhang, Department of Epidemiology and Biostatistics (J.Z.), University of South Carolina, Columbia, SC, USA.
Jonathan Myers, Department of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; Department of Cardiology, Stanford University, Stanford, CA, USA.

Document Type

Journal Article

Publication Date

4-4-2025

Journal

Mayo Clinic proceedings

DOI

10.1016/j.mayocp.2024.09.023

Abstract

OBJECTIVE: To assess the association between objectively measured cardiorespiratory fitness (CRF) and mortality in patients with chronic kidney disease (CKD). PATIENTS AND METHODS: From a large cohort of US veterans (n=750,302) based on the ETHOS (Exercise Testing and Health Outcomes) study, we identified 45,674 men and women aged 30 to 95 years (mean, 65.1 ± 8.8 years) who completed an exercise treadmill test (ETT) within the Veterans Affairs hospitals across the United States. All were diagnosed with CKD before the ETT by International Classification of Diseases 9 and 10 revision codes. Age- and-sex-specific CRF categories (quintiles) were established based on peak metabolic equivalents (METs) achieved during the ETT. We computed HRs and 95% CIs with Cox regression analyses adjusted for comorbidities and medications. RESULTS: During 15.9 years of follow-up, 24,310 individuals (53.2%) died. The adjusted association between CRF and mortality risk was inverse and graded. For each 1-MET increase in CRF, the adjusted HR for mortality was 12% lower (HR, 0.88; 95% CI, 0.875 to 0.885; P<.001). When risk was assessed across CRF categories using the least-fit CRF category as the referent, the adjusted HRs and CIs were 0.76 (95% CI, 0.73 to 0.78), 0.63 (95% CI, 0.61 to 0.66), 0.49 (95% CI, 0.47 to 0.51), and 0.33 (95% CI, 0.30 to 0.35), for low-fit, moderate-fit, fit, and high-fit individuals, respectively. The pattern of the CRF mortality risk association was similar regardless of age, race, or sex. CONCLUSION: In this large multiethnic study, we found an independent, inverse, and graded association between CRF and mortality in CKD patients. These findings underscore the importance of increasing CRF in CKD patients to lower the risk of mortality.

APA Citation

Sui, Xuemei; Kokkinos, Peter; Faselis, Charles; Samuel, Immanuel Babu; Pittaras, Andreas; Gollie, Jared; Patel, Samir; Lavie, Carl J.; Zhang, Jiajia; and Myers, Jonathan, "Cardiorespiratory Fitness and Mortality in Patients With Chronic Kidney Disease: A Prospective Cohort Study" (2025). GW Authored Works. Paper 7098.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7098

Department

Clinical Research and Leadership