Date: Sunday, June 12, 2016
Session Name: Poster Session B: Kidney: Cardiovascular and Metabolic
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Background: Cardiovascular disease (CVD) is a major health care concern in end-stage renal disease (ESRD). Peak oxygen uptake (VO2peak) is a strong predictor of CVD and all-cause mortality, but its utility in ESRD patients is unknown.
Aim: Determine whether VO2peak is a better predictor of CVD and all-cause mortality compared with troponin-T (established CVD risk marker in ESRD), among patients being evaluated for kidney transplant (TX).
Methods: In 2012 Mayo Clinic AZ incorporated VO2peak into the CVD screening algorithm among high-risk patients being evaluated for kidney TX. High-risk patients (>50 years, ± history of diabetes, ± history of CVD) underwent VO2peak testing, if VO2peak is <17ml/kg/min MIBI is performed. Patients with documented VO2peak testing and troponin T were followed for CVD events (non-fatal MI, ischemia, CABG, CVA and arrhythmia) and all-cause deaths. VO2peak and troponin T were transformed to standardized scores (Z-score). The significance of these variables were tested using Cox proportional hazards, logistic regression models, and likelihood ratio statistics with/without adjustment for covariates (age, sex, race, hypertension, dyslipidemia, smoking, diabetes, and kidney tx status).
Results: During an average of 2.3 years follow-up among 374 patients, there were 57 cardiac events and 40 total deaths.
|End-points||Male (N=228)||Female (N=146)|
Both VO2peak and troponin T were independent predictors of CVD events without adjustment for covariates. The hazard ratios (95% CI) for VO2peak and troponin T were 0.62 (0.45, 0.85) and 1.29 (1.05, 1.58) for CVD events, respectively, as a single measure. After adjustment for covariates, higher VO2peak [HR=0.58 (0.41, 0.81); p=0.002] was associated with lower risk of CVD events, but troponin T was not [HR=1.24 (0.99, 1.57); p=0.07]. Odds ratios (OR) for all-cause mortality were similar. After adjustment for covariates, higher VO2peak was associated with lower risk of all-cause mortality [OR=0.55 (0.35, 0.87); p=0.01], but troponin T was nonsignificant [OR=1.20 (0.92, 1.58); p=0.18].
Conclusion: VO2peak is a strong predictor of CVD events and all-cause mortality among ESRD patients being evaluated for TX and may have utility for risk stratification of these patients.
CITATION INFORMATION: Chakkera H, Lee C, Dickinson J, Kaplan B, Qaqish I, Behmen S, Heilman R, Khamash H, Huskey J, Nair S, Scott R, Steidley D, Temkit M, Angadi S. VO2peak Outperforms Troponin T for Risk Prediction of Cardiovascular Disease and All-Cause Mortality in Patients with End Stage Renal Disease Being Evaluated for Kidney Transplant. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Chakkera H, Lee C, Dickinson J, Kaplan B, Qaqish I, Behmen S, Heilman R, Khamash H, Huskey J, Nair S, Scott R, Steidley D, Temkit M, Angadi S. VO2peak Outperforms Troponin T for Risk Prediction of Cardiovascular Disease and All-Cause Mortality in Patients with End Stage Renal Disease Being Evaluated for Kidney Transplant. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/vo2peak-outperforms-troponin-t-for-risk-prediction-of-cardiovascular-disease-and-all-cause-mortality-in-patients-with-end-stage-renal-disease-being-evaluated-for-kidney-transplant/. Accessed June 26, 2019.
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