Aerobic exercise capacity and incident chronic kidney disease in patients with heart failure with preserved ejection fraction

Background: Chronic kidney disease (CKD) is prevalent among patients with heart failure with preserved ejection fraction (HFpEF), significantly affecting their outcomes.Although the prognostic risk factors remain unclear, peak oxygen consumption (peak VO 2 ) may be used to objectively assess the risk of kidney damage due to overlapping factors affecting kidney function and aerobic exercise capacity.This study aimed to evaluate the association between peak VO 2 levels and incident CKD risk among patients with HFpEF.Methods: A total of 342 patients with HFpEF and an estimated glomerular filtration rate (eGFR) >60 mL/min/1.73m 2 who underwent cardiopulmonary exercise testing between January 2012 and April 2021 were included.Aerobic exercise capacity was evaluated using the peak VO 2 values.Incident CKD development was defined as two consecutive eGFR measurements <60 mL/min/1.73m 2 separated by ≥90 days.Results: The mean patient age was 62.9 ± 10.6 years, with 35.7% being male.Baseline left ventricular ejection fraction and eGFR were 66.7% ± 6.9% and 88.4 ± 12.6 mL/min/1.73m 2 , respectively.For over 940.0 person-years of follow-up (median, 2.9 years), 51 patients developed CKD.CKD incidence rate gradually increased with lower peak VO 2 levels.Multivariable Cox analysis showed an association between a 1-standard-deviation peak VO 2 increase and a 51% reduction in CKD risk.The adjusted hazard ratio (95% confidence interval) for the lowest peak VO 2 tertile group was 3.29 (1.23-8.84)compared with the highest tertile group.Conclusion: Reduced aerobic exercise capacity, indicated by lower peak VO 2 levels, is closely associated with an increased CKD risk in patients with HFpEF.