Peter Kokkinos1, Charles Faselis2, Jonathan Myers3, Xuemei Sui4, Jiajia Zhang5, Apostolos Tsimploulis6, Lakhmir Chawla7, Carlos Palant7. 1. Cardiology Department, Veterans Affairs Medical Center, Washington, DC; Georgetown University Medical Center, Washington, DC; George Washington University School of Medicine, Washington, DC; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia. Electronic address: peter.kokkinos@va.gov. 2. George Washington University School of Medicine, Washington, DC; Department of Medicine, Veterans Affairs Medical Center, Washington, DC. 3. Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford University, Stanford, CA. 4. Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia. 5. Department of Epidemiology and Biostatistics, University of South Carolina, Columbia. 6. Department of Medicine, Veterans Affairs Medical Center, Washington, DC. 7. George Washington University School of Medicine, Washington, DC; Nephrology Department, Veterans Affairs Medical Center, Washington, DC.
Abstract
OBJECTIVE: To assess the association between exercise capacity and the risk of developing chronic kidney disease (CKD). PATIENTS AND METHODS: Exercise capacity was assessed in 5812 male veterans (mean age, 58.4±11.5 years) from the Veterans Affairs Medical Center, Washington, DC. Study participants had an estimated glomerular filtration rate of 60 mL/min per 1.73 m(2) or more 6 months before exercise testing and no evidence of CKD. Those who developed CKD during follow-up were initially identified by the International Classification of Diseases, Ninth Revision and further verified by at least 2 consecutive estimated glomerular filtration rate values of less than 60 mL/min per 1.73 m(2) 3 months or more apart. Normal kidney function for CKD-free individuals was confirmed by sequential normal eGFR levels. We established 4 fitness categories on the basis of age-stratified quartiles of peak metabolic equivalents (METs) achieved: least-fit (≤25%; 4.8±0.90 METs; n=1258); low-fit (25.1%-50%; 6.5±0.96 METs; n=1614); moderate-fit (50.1%-75%; 7.7±0.91 METs; n=1958), and high-fit (>75%; 9.5±1.0 METs; n=1436). Multivariable Cox proportional hazard models were used to assess the association between exercise capacity and CKD. RESULTS: During a median follow-up period of 7.9 years, 1010 developed CKD (20.4/1000 person-years). Exercise capacity was inversely related to CKD incidence. The risk was 22% lower (hazard ratio, 0.78; 95% CI, 0.75-0.82; P<.001) for every 1-MET increase in exercise capacity. Compared with the least-fit individuals, hazard ratios were 0.87 (95% CI, 0.74-1.03) for low-fit, 0.55 (95% CI, 0.47-0.65) for moderate-fit, and 0.42 (95% CI, 0.33-0.52) for high-fit individuals. CONCLUSION: Higher exercise capacity attenuated the risk of developing CKD. The association was independent and graded.
OBJECTIVE: To assess the association between exercise capacity and the risk of developing chronic kidney disease (CKD). PATIENTS AND METHODS: Exercise capacity was assessed in 5812 male veterans (mean age, 58.4±11.5 years) from the Veterans Affairs Medical Center, Washington, DC. Study participants had an estimated glomerular filtration rate of 60 mL/min per 1.73 m(2) or more 6 months before exercise testing and no evidence of CKD. Those who developed CKD during follow-up were initially identified by the International Classification of Diseases, Ninth Revision and further verified by at least 2 consecutive estimated glomerular filtration rate values of less than 60 mL/min per 1.73 m(2) 3 months or more apart. Normal kidney function for CKD-free individuals was confirmed by sequential normal eGFR levels. We established 4 fitness categories on the basis of age-stratified quartiles of peak metabolic equivalents (METs) achieved: least-fit (≤25%; 4.8±0.90 METs; n=1258); low-fit (25.1%-50%; 6.5±0.96 METs; n=1614); moderate-fit (50.1%-75%; 7.7±0.91 METs; n=1958), and high-fit (>75%; 9.5±1.0 METs; n=1436). Multivariable Cox proportional hazard models were used to assess the association between exercise capacity and CKD. RESULTS: During a median follow-up period of 7.9 years, 1010 developed CKD (20.4/1000 person-years). Exercise capacity was inversely related to CKD incidence. The risk was 22% lower (hazard ratio, 0.78; 95% CI, 0.75-0.82; P<.001) for every 1-MET increase in exercise capacity. Compared with the least-fit individuals, hazard ratios were 0.87 (95% CI, 0.74-1.03) for low-fit, 0.55 (95% CI, 0.47-0.65) for moderate-fit, and 0.42 (95% CI, 0.33-0.52) for high-fit individuals. CONCLUSION: Higher exercise capacity attenuated the risk of developing CKD. The association was independent and graded.
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