Purpose Aerobic exercise capacity is reduced in patients with chronic kidney disease, partly due to alterations at the muscular and microvascular level. This study evaluated oxygen uptake (VO2) kinetics as indicator of muscular oxidative metabolism in a population of Kidney Transplant Recipients (KTRs). Methods Two groups of KTRs enrolled 3 (n = 21) and 12 months (n = 14) after transplantation and a control group of healthy young adults (n = 16) underwent cardiopulmonary exercise testing on cycle-ergometer. The protocol consisted in two subsequent constant, moderate-load exercise phases with a final incremental test until exhaustion. Results The time constant of VO2 kinetics was slower in KTRs at 3 and 12 months after transplantation compared to controls (50.4 ± 13.1 s and 43.8 ± 11.6 s vs 28.9 ± 8.4 s, respectively; P < 0.01). Peak VO2 was lower in KTRs evaluated 3 months after transplantation compared to patients evaluated after 1 year (21.3 ± 4.3 and 26.4 ± 8.0 mL/kg/min; P = 0.04). Blood haemoglobin (Hb) concentration was higher in KTRs evaluated at 12 months (12.8 ± 1.7 vs 14.6 ± 1.7 g/dL; P < 0.01). Among KTRs, τ showed a moderate negative correlation with Peak VO2 (ρ = − 0.52) and Oxygen uptake efficiency slope (OUES) (r = − 0.57) while no significant correlation with Hb and peak heart rate. Conclusions KTRs show slower VO2 kinetics compared to healthy controls. Hb and peak VO2 seem to improve during the first year after transplantation. VO2 kinetics were significantly associated with indices of cardiorespiratory fitness, but less with central determinants of aerobic capacity, thus suggesting a potential usefulness of adding this index of muscular oxidative metabolism to functional evaluation in KTRs.

The prevalence of ΔPsys ≥ 10 mmHg in this population was only slightly lower than what observed in older, hypertensive or diabetic patients. Cases and Controls did not differ in physical activity level, ankle brachial pressure index and CV risk. However, low test-retest reliability might limit the use of ΔPsys as a reliable marker for CV screening in this population.

<b><i>Introduction:</i></b> Infectious events are one of the leading causes of death in kidney transplant recipients (KTRs). KTRs have reduced cardiorespiratory fitness (CRF), a predictor for infections in other populations. The aim of this study was to investigate whether CRF and muscle strength are prognostic markers for infectious events in KTRs. <b><i>Methods:</i></b> In this retrospective cohort study, 155 KTRs underwent an incremental, maximal cardiopulmonary exercise test (CPET) 3 months after transplantation. CRF was analyzed with peak oxygen consumption (VO₂ peak) while muscle strength with isometric handgrip (HG) test. Laboratory blood samples and drug therapy were collected. The median follow-up period was 54 (interquartile range 38–62) months. Cox regression analyses were performed to evaluate predictors of infectious events adjusting for potential confounders. <b><i>Results:</i></b> During this study, severe infectious events occurred in 41 subjects (26.5%). 15.5% (<i>n</i> = 24) of patients had a severely reduced CRF, defined as a VO₂ peak below the 5th percentile of the reference values reported for a matched healthy population. The hazard ratio for infectious events in this subgroup was 2.389 (95% CI = 1.188–4.801, <i>p</i> = 0.014), independently of gender, age, BMI, time on dialysis, hemoglobin concentration, eGFR, diabetes, and immunosuppressive regimen. On the contrary, no significant association of HG strength and infections was found. <b><i>Conclusion:</i></b> Therefore, low CRF may be considered as a modifiable predictor of severe infectious events in KTRs. A CPET should thus be recommended for cardiovascular screening, evaluation of CRF, and tailored exercise prescription to reduce the risk of infections and potentially improve long-term outcomes of transplantation.

Funding Acknowledgements Type of funding sources: None. Background Kidney transplant recipients (KTRs) have an increased cardiovascular risk and lower cardiorespiratory fitness (CRF). This is associated with increased all-cause mortality and can drastically reduce quality of life. Therefore, assessment of functional capacity and consequently an individualized physical exercise prescription are important respectively for prognostic and therapeutic purposes. Purpose Evaluate whether functional capacity, expressed as maximum oxygen consumption (VO2peak/Kg) and physical activity level are independent determinants of the risk of major cardio-vascular events (MACEs) in a KTRs population in the medium to long term. Methods In this retrospectively cohort study, 168 KTRs transplanted between 2014 and 2018 were enrolled. They underwent to a complete medical evaluation, a cardiopulmonary exercise testing and GPAQ questionnaire 3-12 months after transplantation. Laboratory blood samples and drug therapy data were collected. The average follow-up period was 6,13 ± 1,63 years. In July 2022, an anamnestic questionnaire (in order to investigate MACEs) and GPAQ questionnaire were submitted by telephone to all patients. Cox regression analyses were performed to evaluate predictors of MACEs adjusting for potential confounders. Results During the study, MACEs occurs in 15 patients (8.93%). Subjects who underwent MACE had a functional capacity significantly lower than those who had no events. Moreover, patients with MACE also had levels of physical activity significantly reduced compared with the ones without events (Table I). Data shows that VO2peak/Kg is a protective marker for risk of MACEs (Hazard Ratio 0.836; 95%CI= 0.715-0.978; p=0.025), independently of gender, age, hypertension, dyslipidaemia, obesity, diabetes mellitus, eGFR, physical activity level and presence of major cardiovascular events before transplantation. Moreover, classifying severity of functional capacity reduction through reference values reported for a matched healthy population, rate of MACEs significantly increases in groups of patients with worse CRF compared to healthy subjects (p=0.027). Conclusions In KRTs, better functional capacity after transplantation seems to be an independent modifiable protective factor for MACEs in the medium to long term. Cardiopulmonary exercise testing should thus be recommended for cardiovascular screening, evaluation of CRF and tailored exercise prescription to reduce the risk of major cardiovascular events.

Background: Sedentary behaviour (SB) and physical inactivity (PI) are associated with an increased risk of chronic diseases and a significant economic burden. This pilot study aims to estimate the possible cost savings for the Veneto Regional Health Service (Italy) due to a population-based physical activity (PA) intervention. Methods: The PA-related cost-savings were assessed for four chronic diseases in the whole and sedentary populations of the Veneto region. The SB and PA epidemiological data, regarding an additional percutaneous coronary intervention in coronary artery disease, hospitalizations in chronic obstructive pulmonary disease, surgery for colorectal cancer, and femur fracture, were obtained from national and regional administrative sources. A relative risk reduction, due to PA, was obtained from the recent literature. The annual healthcare costs were estimated using the regional diagnosis-related group tariffs. Results: The annual estimated cost-savings for the regional healthcare service related to these four outcomes: an amount between EUR 5,310,179 (if a conservative analysis was performed) and EUR 17,411,317. Conclusion: By a downward estimate, regarding the direct healthcare costs, PA interventions could lead to important cost-savings in the Veneto region. The savings would be greater when considering the cross-sectional impact on other healthcare costs, comorbidities, and indirect costs.