van den Bosch E; Bossers SSM; Kamphuis VP; Boersma E; Roos-Hesselink JW;
Breur JMPJ; Ten Harkel ADJ; Kapusta L; Bartelds B; Roest AAW; Kuipers IM;
Blom NA; Koopman LP; Helbing WA

Journal of the American Heart Association. 10(5):e015022, 2021 02. VI 1

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 (VO2
peak/VO2 max) 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.