Introduction: Current screening algorithms for coronary artery disease (CAD) before kidney transplantation result in many tests but few interventions. Objective: The aim of this study was to study the utility of 6-minute walk test (6MWT), an office-based test of cardiorespiratory fitness, for risk stratification in this setting. Methods: We enrolled 360 patients who are near the top of the kidney transplant waitlist at our institution. All patients underwent CAD evaluation irrespective of 6MWT results. We examined the association between 6MWT and time to CAD-related events (defined as cardiac death, revascularization, nonfatal myocardial infarction, and removal from the waitlist for CAD), treating noncardiac death and waitlist removal for non-CAD reasons as competing events. Results: The 6MWT-based approach designated approximately 45% of patients as “low risk,” whereas a risk factor- or symptom-based approach designated 14 and 81% of patients as “low risk,” respectively. The 6MWT-based approach was not significantly associated with CAD-related events within 1 year (subproportional hazard ratio [sHR] 1.00 [0.90–1.11] per 50 m) but was significantly associated with competing events (sHR 0.70 [0.66–0.75] per 50 m). In a companion analysis, removing waitlist status from consideration, 6MWT result was associated with the development of CAD-related events (sHR 0.92 [0.84–1.00] per 50 m). Conclusions: The 6MWT designates fewer patients as high risk and in need of further testing (compared to risk factor-based approaches), but its utility as a pure CAD risk stratification tool is modulated by the background waitlist removal rate. CAD screening before kidney transplant should be tailored according to a patient’s actual chance of receiving a transplant.
Cardiorenal Med

中文翻译：

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候补肾移植候选者冠状动脉疾病筛查的表现与基于风险因素的方法

简介：目前肾移植前冠状动脉疾病 (CAD) 的筛查算法导致了许多测试，但干预措施很少。目的：本研究的目的是研究 6 分钟步行测试 (6MWT) 的效用，这是一种基于办公室的心肺健康测试，用于在这种情况下进行风险分层。方法：我们招募了 360 名接近我们机构肾移植候补名单顶部的患者。无论 6MWT 结果如何，所有患者都接受了 CAD 评估。我们检查了 6MWT 与 CAD 相关事件（定义为心源性死亡、血运重建、非致死性心肌梗死和从 CAD 候补名单中移除）之间的关联，将非心源性死亡和非 CAD 原因导致候补名单移除视为竞争事件。结果：基于 6MWT 的方法将大约 45% 的患者指定为“低风险”，而基于风险因素或症状的方法分别将 14% 和 81% 的患者指定为“低风险”。基于 6MWT 的方法与 1 年内 CAD 相关事件没有显着相关性（亚比例风险比 [sHR] 1.00 [0.90–1.11] 每 50 m），但与竞争事件显着相关（sHR 0.70 [0.66–0.75] 每50公尺）。在一项伴随分析中，从考虑中去除候补名单状态，6MWT 结果与 CAD 相关事件的发展相关（sHR 0.92 [0.84-1.00] 每 50 m）。结论：6MWT 将较少的患者指定为高风险并需要进一步测试（与基于风险因素的方法相比），但其作为纯 CAD 风险分层工具的效用受背景候补名单移除率的调节。肾移植前的 CAD 筛查应根据患者接受移植的实际机会进行调整。
心肾医学