For Renal Function, Cardiac Rehab Provides the Most Benefit to Those Who Most Need It

Recent research presented at the European Society of Cardiology 2020 Congress shows that for patients with chronic kidney disease (CKD), the benefits of cardiac rehabilitation are greatest for those whose renal function had most deteriorated when therapy began.

Tomoaki Hama, of the Division of Cardiology at Tokai University Hachioji-Hospital in Japan, had previously led a study that found cardiac rehabilitation brought significant improvement in renal function in patients with cardiovascular disease (CVD), using cystatin C. The new findings presented at ESC sought to measure whether the severity of renal impairment at the start of rehab affected the level of improvement.

The findings are important to managed care because they could help health systems stratify which patients should be referred for cardiac rehabilitation. Cardiac rehab can include both dietary changes and increased exercise, as well as education and training to reduce stress and adopt behaviors that improve cardiovascular fitness.

Researchers studied 203 CVD patients (155 men; average age, 73 years), with CKD who took part in a 3-month cardiac rehabilitation program. The group’s CKD was evaluated at baseline using with an estimated glomerular filtration ratio using the serum cystatin C concentration, or eGFRcys, and all had 15≤eGFRcys<60 mL/min/1.73m².

Patients were divided into 3 groups based on severity of their renal impairment at the start of rehab:

• 122 patients in CKD group G3a (45≤eGFRcys<60 mL/min/1.73m²)
• 60 patients in CKD group G3b (30≤eGFRcys<45 mL/min/1.73m²)
• 21 patients in CKD group G4 (15≤eGFRcys<30 mL/min/1.73m²)

The researchers compared renal function at the start and end of cardiac rehabilitation in all 3 groups, examining the size of the change for each group. Across all 3 groups there was an improvement, with the eGFRcys increasing from 45.5 to 47.7 mL/min/1.73m² (P < .001).

In the G3b group, eGFRcys improved (38.4 to 41.5 mL/min/1.73m², P = .001); in G4, the improvement was 23.2 to 28.0 mL/min/1.73m² (P = .016). However, in the G3a group, the eGFRcys increase was not statistically significant (52.9 to 54.2 mL/min/1.73m²; P = .074).

Researchers concluded, “The greater the renal dysfunction in the CVD patients with CKD was, the greater the improvement in the renal function after participating in the [cardiac rehabilitation] program.”

Reference

Hama Y, Ushijima A, Ikari Y, et al. The lower the renal function in patients with chronic renal disease, the greater the improvement in the renal function cardiac rehabilitation provides. Presented at the European Society of Cardiology 2020 Congress.