Satish, Pranav;
Smith, Rebecca;
Alasadi, Ala;
Frackiewicz, Ewa;
Fernando, Raymond;
Jeetley, Paramjit;
Wittenberg, Marc;
... Jones, Gareth; + view all
(2025)
A simple test of walking speed during transplant preassessment predicts positive cardiac investigations and mortality.
Nephrol Dial Transplant
, Article gfaf094. 10.1093/ndt/gfaf094.
(In press).
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Abstract
Background and Hypothesis: Prior to renal transplant listing, cardiovascular screening is performed to stratify the risk of cardiovascular disease (CVD). However, the added benefit of screening patients with formal cardiac testing remains unclear. In our centre, patients being assessed for transplant underwent a timed assessment to walk 130 m to quantify exercise tolerance. This study examines the efficacy of this test to predict cardiovascular screening results and post-transplantation outcomes.// Methods: We retrospectively analysed 995 patients in a single centre who underwent pre-transplant assessment, which included the walking test time (WTT) in addition to established cardiac screening protocols. Patients were divided into quartiles of the time taken to perform the walk test. We calculated the test's predictive value using sensitivity analysis. Significant covariates in predicting death and CV events were identified. Kaplan-Meier analysis indicated survival times between quartiles.// Results: The fastest quartile (Q1) of WTT were younger, had lower BMIs, were less frail, had lower rates of CVD and diabetes at baseline. Q1 had lower rates of cardiac events and mortality compared to the slowest quartile of WTT (Q4) (1.62% vs 10.6% in Q4, p < 0.001,). Q1 had lower rates of abnormal cardiac stress testing (13.8% Q1 vs 22.8% Q4, p = 0.052) and higher rates of activation for transplantation (90.6% Q1 vs 55.3% Q4, p < 0.001). Transplant rates were similar between quartiles (69.7% Q1 vs 71.2% Q4, p = 0.767). Walk time was a significant predictor of cardiac events (HR 1.011, p = 0.048) but not of mortality (HR = 1.003, p = 0.446). Sensitivity analysis showed a high negative predictive value (86.2%) for WTT as a predictor of stress test results.// Conclusions: We present a rapid, non-invasive method of assessing cardiorespiratory function before renal transplantation. Current protocols for pre-transplant assessment may over-investigate patients with low cardiovascular risk, thereby delaying activation and subsequent transplant. Frailer, older patients with CVD and diabetes may benefit from focussed cardiac screening.
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