{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:24:54Z","timestamp":1787163894687,"version":"build-2736575974"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T00:00:00Z","timestamp":1748476800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100017158","name":"Royal Free Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017158","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,30]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prior to renal transplant listing, cardiovascular screening is performed to stratify the risk of cardiovascular disease (CVD). However, the added benefit of screening patients with formal cardiac testing remains unclear. In our centre, patients being assessed for transplant underwent a timed assessment to walk 130\u00a0m to quantify exercise tolerance. This study examines the efficacy of this test to predict cardiovascular screening results and post-transplantation outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analysed 995 patients in a single centre who underwent pretransplant assessment, which included the walk test time (WTT) in addition to established cardiac screening protocols. Patients were divided into quartiles of the time taken to perform the walk test. We calculated the test's predictive value using sensitivity analysis. Significant covariates in predicting death and cardiovascular events were identified. Kaplan\u2013Meier analysis indicated survival times between quartiles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The fastest quartile (Q1) of WTT were younger, had lower body mass index, were less frail and had lower rates of CVD and diabetes at baseline. Q1 had lower rates of cardiac events and mortality compared with the slowest quartile of WTT (Q4) (1.62% versus 10.6% in Q4; P\u00a0&amp;lt;\u00a0.001). Q1 had lower rates of abnormal cardiac stress testing (13.8% Q1 versus 22.8% Q4; P\u00a0=\u00a0.052) and higher rates of activation for transplantation (90.6% Q1 versus 55.3% Q4; P\u00a0&amp;lt;\u00a00.001). Transplant rates were similar between quartiles (69.7% Q1 versus 71.2% Q4; P\u00a0=\u00a0.767). Walk time was a significant predictor of cardiac events [hazard ratio (HR) 1.011, P\u00a0=\u00a0.048] but not of mortality (HR 1.003, P\u00a0=\u00a0.446). Sensitivity analysis showed a high negative predictive value (86.2%) for WTT as a predictor of stress test results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We present a rapid, non-invasive method of assessing cardiorespiratory function before renal transplantation. Current protocols for pretransplant assessment may overinvestigate patients with low cardiovascular risk, thereby delaying activation and subsequent transplant. Frailer, older patients with CVD and diabetes may benefit from focussed cardiac screening.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfaf094","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T07:40:55Z","timestamp":1748504455000},"page":"2159-2168","source":"Crossref","is-referenced-by-count":1,"title":["A simple test of walking speed during transplant preassessment predicts positive cardiac investigations and mortality"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4531-9114","authenticated-orcid":false,"given":"Pranav","family":"Satish","sequence":"first","affiliation":[{"name":"UCL Centre for Kidney and Bladder Health, Royal Free Hospital , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Smith","sequence":"additional","affiliation":[{"name":"UCL Centre for Kidney and Bladder Health, Royal Free Hospital , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ala","family":"Alasadi","sequence":"additional","affiliation":[{"name":"UCL Centre for Kidney and Bladder Health, Royal Free Hospital , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa","family":"Frackiewicz","sequence":"additional","affiliation":[{"name":"UCL Centre for Kidney and Bladder Health, Royal Free Hospital , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Fernando","sequence":"additional","affiliation":[{"name":"Anthony Nolan Round Table Laboratories Department of Histocompatibility and Immunogenetics, , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paramjit","family":"Jeetley","sequence":"additional","affiliation":[{"name":"Royal Free London NHS Foundation Trust Department of Cardiology, , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Wittenberg","sequence":"additional","affiliation":[{"name":"Royal Free London NHS Foundation Trust Department of Anaesthesia, , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Motallebzadeh","sequence":"additional","affiliation":[{"name":"UCL Centre for Kidney and Bladder Health, Royal Free Hospital , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gareth","family":"Jones","sequence":"additional","affiliation":[{"name":"UCL Centre for Kidney and Bladder Health, Royal Free Hospital , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,5,29]]},"reference":[{"key":"2025102920024071400_bib1","doi-asserted-by":"publisher","first-page":"1725","DOI":"10.1056\/NEJM199912023412303","article-title":"Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant","volume":"341","author":"Wolfe","year":"1999","journal-title":"N Engl J Med"},{"key":"2025102920024071400_bib2","doi-asserted-by":"publisher","first-page":"znae001","DOI":"10.1093\/bjs\/znae001","article-title":"Survival of patients with kidney failure awaiting transplantation stratified by age and ethnicity: population-based cohort analysis","volume":"111","author":"Chaudhry","year":"2024","journal-title":"Br J Surg"},{"issue":"Suppl 2","key":"2025102920024071400_bib3","doi-asserted-by":"publisher","first-page":"ehac544.1053","DOI":"10.1093\/eurheartj\/ehac544.1053","article-title":"Causes of death in patients with chronic kidney disease: insights from the ASCEND-D and ASCEND-ND cardiovascular outcomes trials","volume":"43","author":"Singh","year":"2022","journal-title":"Eur Heart J"},{"key":"2025102920024071400_bib4","doi-asserted-by":"publisher","first-page":"11491","DOI":"10.3389\/ti.2023.11491","article-title":"Survival benefit of kidney transplantation in patients with end-stage kidney disease and prior acute myocardial infarction","volume":"36","author":"Kim","year":"2023","journal-title":"Transpl Int"},{"key":"2025102920024071400_bib5","doi-asserted-by":"publisher","first-page":"2887","DOI":"10.1681\/ASN.2020050566","article-title":"Death after kidney transplantation: an analysis by era and time post-transplant","volume":"31","author":"Ying","year":"2020","journal-title":"J Am Soc Nephrol"},{"key":"2025102920024071400_bib6","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1681\/ASN.2005090984","article-title":"Acute myocardial infarction and kidney transplantation","volume":"17","author":"Kasiske","year":"2006","journal-title":"J Am Soc Nephrol"},{"issue":"4 Suppl 1","key":"2025102920024071400_bib7","doi-asserted-by":"publisher","first-page":"S11","DOI":"10.1097\/TP.0000000000003136","article-title":"KDIGO clinical practice guideline on the evaluation and management of candidates for kidney transplantation","volume":"104","author":"Chadban","year":"2020","journal-title":"Transplantation"},{"key":"2025102920024071400_bib8","doi-asserted-by":"publisher","first-page":"e299","DOI":"10.1161\/CIR.0000000000001104","article-title":"Emerging evidence on coronary heart disease screening in kidney and liver transplantation candidates: a scientific statement from the American Heart Association","volume":"146","author":"Cheng","year":"2022","journal-title":"Circulation"},{"key":"2025102920024071400_bib9","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1016\/0140-6736(92)93010-K","article-title":"Coronary revascularisation in insulin-dependent diabetic patients with chronic renal failure","volume":"340","author":"Manske","year":"1992","journal-title":"Lancet"},{"key":"2025102920024071400_bib10","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1016\/j.jacc.2021.05.001","article-title":"Kidney transplant list status and outcomes in the ISCHEMIA-CKD Trial","volume":"78","author":"Herzog","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2025102920024071400_bib11","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.2215\/CJN.09391010","article-title":"A call to action","volume":"6","author":"Friedman","year":"2011","journal-title":"Clin J Am Soc Nephrol"},{"key":"2025102920024071400_bib12","doi-asserted-by":"publisher","first-page":"1608","DOI":"10.1056\/NEJMoa1915925","article-title":"Management of coronary disease in patients with advanced kidney disease","volume":"382","author":"Bangalore","year":"2020","journal-title":"N Engl J Med"},{"key":"2025102920024071400_bib13","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1001\/jamainternmed.2022.6069","article-title":"Association of pretransplant coronary heart disease testing with early kidney transplant outcomes","volume":"183","author":"Cheng","year":"2023","journal-title":"JAMA Intern Med"},{"key":"2025102920024071400_bib14","doi-asserted-by":"publisher","first-page":"2472","DOI":"10.1093\/ckj\/sfab103","article-title":"Screening for occult coronary artery disease in potential kidney transplant recipients: time for reappraisal?","volume":"14","author":"Ferro","year":"2021","journal-title":"Clin Kidney J"},{"key":"2025102920024071400_bib15","doi-asserted-by":"publisher","first-page":"2020","DOI":"10.1093\/ckj\/sfac149","article-title":"Frailty in kidney transplantation: a review on its evaluation, variation and long-term impact","volume":"15","author":"Alfieri","year":"2022","journal-title":"Clin Kidney J"},{"key":"2025102920024071400_bib16","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1111\/ajt.14430","article-title":"Pre-kidney transplant lower extremity impairment and post-kidney transplant mortality","volume":"18","author":"Nastasi","year":"2018","journal-title":"Am J Transplant"},{"key":"2025102920024071400_bib17","doi-asserted-by":"publisher","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in older adults: evidence for a phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2025102920024071400_bib18","doi-asserted-by":"publisher","first-page":"e003446","DOI":"10.1136\/bmjopen-2013-003446","article-title":"Treadmill walking speed and survival prediction in men with cardiovascular disease: a 10-year follow-up study","volume":"3","author":"Chiaranda","year":"2013","journal-title":"BMJ Open"},{"key":"2025102920024071400_bib19","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1503\/cmaj.050051","article-title":"A global clinical measure of fitness and frailty in elderly people","volume":"173","author":"Rockwood","year":"2005","journal-title":"CMAJ"},{"key":"2025102920024071400_bib20","doi-asserted-by":"crossref","first-page":"e0240912","DOI":"10.1371\/journal.pone.0240912","article-title":"Non-invasive cardiac stress studies may not offer significant benefit in pre-kidney transplant evaluation: a retrospective cohort study","volume":"15","author":"Durga","year":"2020","journal-title":"PLoS One"},{"key":"2025102920024071400_bib21","volume-title":"USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States","author":"United States Renal Data System","year":"2020"},{"key":"2025102920024071400_bib22","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1111\/hdi.13101","article-title":"Comparing the Fried frailty phenotype versus the Veterans Affairs frailty index among dialysis dependent patients","volume":"27","author":"Hamiduzzaman","year":"2023","journal-title":"Hemodial Int"},{"key":"2025102920024071400_bib23","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1001\/archinternmed.2012.3020","article-title":"Frailty, dialysis initiation, and mortality in end-stage renal disease","volume":"172","author":"Bao","year":"2012","journal-title":"Arch Intern Med"},{"key":"2025102920024071400_bib24","doi-asserted-by":"publisher","first-page":"e701","DOI":"10.1097\/TXD.0000000000001156","article-title":"Frailty and kidney transplantation: a systematic review and meta-analysis","volume":"7","author":"Quint","year":"2021","journal-title":"Transplant Direct"},{"key":"2025102920024071400_bib25","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1111\/ajt.12992","article-title":"Frailty and mortality in kidney transplant recipients","volume":"15","author":"McAdams-DeMarco","year":"2015","journal-title":"Am J Transplant"},{"key":"2025102920024071400_bib26","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1001\/jama.2010.1923","article-title":"Gait speed and survival in older adults","volume":"305","author":"Studenski","year":"2011","journal-title":"JAMA"},{"key":"2025102920024071400_bib27","doi-asserted-by":"publisher","first-page":"1668","DOI":"10.1016\/j.jacc.2010.06.039","article-title":"Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery","volume":"56","author":"Afilalo","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"2025102920024071400_bib28","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1016\/S0002-9149(01)01975-0","article-title":"Prognostic usefulness of the six-minute walk in patients with advanced congestive heart failure secondary to ischemic or nonischemic cardiomyopathy","volume":"88","author":"Shah","year":"2001","journal-title":"Am J Cardiol"},{"key":"2025102920024071400_bib29","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/S1836-9553(13)70182-6","article-title":"Distance covered during a six-minute walk test predicts long-term cardiovascular mortality and hospitalisation rates in men with systolic heart failure: an observational study","volume":"59","author":"Wegrzynowska-Teodorczyk","year":"2013","journal-title":"J Physiother"},{"key":"2025102920024071400_bib30","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/j.bja.2019.11.025","article-title":"Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study","volume":"124","author":"Wijeysundera","year":"2020","journal-title":"Br J Anaesth"},{"key":"2025102920024071400_bib31","doi-asserted-by":"crossref","first-page":"2631","DOI":"10.1016\/S0140-6736(18)31131-0","article-title":"Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study","volume":"391","author":"Shulman","year":"2018","journal-title":"Lancet"},{"key":"2025102920024071400_bib32","doi-asserted-by":"publisher","first-page":"e15167","DOI":"10.1111\/ctr.15167","article-title":"Multidisciplinary perspectives on cardiac assessment before kidney transplantation: results from a UK survey","volume":"38","author":"Nimmo","year":"2024","journal-title":"Clin Transplant"}],"container-title":["Nephrology Dialysis Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ndt\/advance-article-pdf\/doi\/10.1093\/ndt\/gfaf094\/63400107\/gfaf094.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ndt\/article-pdf\/40\/11\/2159\/65001667\/gfaf094.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ndt\/article-pdf\/40\/11\/2159\/65001667\/gfaf094.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:02:51Z","timestamp":1761782571000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ndt\/article\/40\/11\/2159\/8152908"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,29]]},"references-count":32,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,5,29]]},"published-print":{"date-parts":[[2025,10,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ndt\/gfaf094","relation":{},"ISSN":["0931-0509","1460-2385"],"issn-type":[{"value":"0931-0509","type":"print"},{"value":"1460-2385","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,11]]},"published":{"date-parts":[[2025,5,29]]}}}