Prognostic Value of Cardiorespiratory Fitness in Patients with Chronic Kidney Disease: The FIT (Henry Ford Exercise Testing) Project.

Abstract Purpose : To study the association of cardiorespiratory fitness (cardiorespiratory fitness) and all-cause mortality among patients with chronic kidney disease. Methods : We studied a retrospective cohort of patients from the Henry Ford Health System who underwent clinically indicated exercise stress testing with baseline cardiorespiratory fitness and estimated glomerular filtration rate measurement. Cardiorespiratory fitness was expressed as metabolic equivalents of task and kidney function was categorized into stages according to estimated glomerular filtration rate. Multivariable-adjusted Cox proportional hazard models were used to examine the association between metabolic equivalents of task and all-cause mortality among patients with chronic kidney disease stages 3 to 5. Discrimination of mortality was assessed using receiver operating characteristic curves, while reclassification was evaluated using net reclassification index (NRI). Results : Among 50,121 participants, the mean age was 55 ± 12.6 years, 47.5% were women, 64.5% were white, and 6,877 (13.7%) participants had chronic kidney disease stage 3-5. Over a median follow-up of 6.7 years, 6,308 participants died (12.6%). Each 1-unit higher metabolic equivalents of task was associated with a significant 15% reduction in all-cause mortality (Hazard Ratio = 0.85, 95% Confidence Interval [CI] 0.84-0.87). Metabolic equivalents of task improved discriminatory ability of mortality prediction when added to traditional risk factors and estimated glomerular filtration rate (area under the curve=0.7996; 95% CI 0.789-0.810 vs 0.759; 95% CI 0.748-0.770, respectively; p-value Conclusions : Cardiorespiratory fitness improves mortality risk prediction among patients with chronic kidney disease. Cardiorespiratory fitness provides incremental prognostic information when added to traditional risk factors and may help guide treatment options among patients with renal dysfunction.