Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece.
Am J Nephrol. 2021;52(4):264-278. doi: 10.1159/000515384. Epub 2021 Apr 21.
Chronic kidney disease (CKD) is often characterized by increased prevalence of cardiovascular risk factors and increased incidence of cardiovascular events and death. Reduced cardiovascular reserve and exercise intolerance are common in patients with CKD and are associated with adverse outcomes.
The gold standard for identifying exercise limitation is cardiopulmonary exercise testing (CPET). CPET provides an integrative evaluation of cardiovascular, pulmonary, hematopoietic, neuropsychological, and metabolic function during maximal or submaximal exercise. It is useful in clinical setting for differentiation of the causes of exercise intolerance, risk stratification, and assessment of response to relevant treatments. A number of recent studies have used CPET in patients with pre-dialysis CKD, aiming to assess the cardiovascular reserve of these individuals, as well as the effect of interventions such as exercise training programs on their functional capacity. This review provides an in-depth description of CPET methodology and an overview of studies that utilized CPET technology to assess cardiovascular reserve in patients with pre-dialysis CKD. Key Messages: CPET can delineate multisystem changes and offer comprehensive phenotyping of factors determining overall cardiovascular risk. Potential clinical applications of CPET in CKD patients range from objective diagnosis of exercise intolerance to preoperative and long-term risk stratification and providing intermediate endpoints for clinical trials. Future studies should delineate the association of CPET indexes, with cardiovascular and respiratory alterations and hard outcomes in CKD patients, to enhance its diagnostic and prognostic utility in this population.
慢性肾脏病（CKD）常以心血管危险因素的患病率增加和心血管事件及死亡发生率升高为特征。心血管储备减少和运动不耐受是 CKD 患者的常见表现，与不良结局相关。
识别运动受限的金标准是心肺运动试验（CPET）。CPET 可在最大或次最大运动期间对心血管、肺、血液、神经心理和代谢功能进行综合评估。它在临床环境中可用于区分运动不耐受的原因、风险分层以及评估相关治疗的反应。最近的一些研究在接受透析前 CKD 患者中使用了 CPET，旨在评估这些患者的心血管储备，以及运动训练计划等干预措施对其功能能力的影响。本综述深入描述了 CPET 方法学，并概述了利用 CPET 技术评估接受透析前 CKD 患者心血管储备的研究。
CPET 可描绘多系统变化，并提供决定整体心血管风险的综合因素表型。CPET 在 CKD 患者中的潜在临床应用范围从运动不耐受的客观诊断到术前和长期风险分层，并为临床试验提供中间终点。未来的研究应明确 CPET 指标与 CKD 患者心血管和呼吸改变及硬终点的相关性，以增强其在该人群中的诊断和预后实用性。
