Low cardiorespiratory fitness (CRF) predicts risk for severe infectious events in kidney transplant recipients (KTRs) and might be modifiable, according to investigators.  

At 3 months after kidney transplantation, 155 patients underwent an incremental, maximal cardiopulmonary exercise test (CPET). Of these, 24 patients (15.5%) had severely reduced CRF, defined as a peak oxygen consumption (VO2)below the 5th percentile of the reference values reported for a matched healthy population.

This subset with low VO2 had a significant 2.4-fold increased risk for infectious events compared with the subset with higher VO2, regardless of gender, age, body mass index (BMI), dialysis vintage, hemoglobin, estimated glomerular filtration rate (eGFR), diabetes, and immunosuppressive regimen, Daniel Neunhaeuserer, MD, PhD, of the University Hospital of Padova, Padova, Italy, and colleagues reported in the American Journal of Nephrology. In contrast, poor hand-grip strength, a marker of sarcopenia or energy protein wasting, was not associated with infection risk.

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According to the investigators, CPET should be performed for cardiovascular screening, evaluation of CRF, and tailored exercise prescription to reduce the risk of infections and potentially improve long-term outcomes of transplantation. They recommended regular, individualized exercise (both aerobic and resistance training) at moderate intensity to improve or maintain CRF.


Ortolan S, Neunhaeuserer D, Battista F, et al. Physical fitness as a prognostic marker for infectious events in kidney transplant recipients. Am J Nephrol. 2022;53:1-9. doi:10.1159/000520758