Authors
Oscar Werner, Marc Fila, Fanchon Herman, Marion Audié, Jérôme Harambat, Brigitte Llanas, Denis Morin, Nabila Djouadi, Stefan Matecki, Sophie Guillaumont, Marie Vincenti, Gregoire De La Villeon, Victor Pommier, Gwenaelle Roussey, Solene Prigent, Alban-Elouen Baruteau, Hamouda Abassi, Mathieu Andrianoely, Julie Tenenbaum, Arthur Gavotto, Arielle Desir, Mary-Kate Batterton, Marie-Christine Picot, Pascal Amedro, QUALIREHAB study group
Published in
Clinical journal of the American Society of Nephrology : CJASN. Jul 22, 2026. Epub Jul 22, 2026.
Abstract
Children with chronic kidney disease (CKD) are at high cardiovascular risk, yet cardiopulmonary fitness is rarely assessed in routine care. Maximal oxygen uptake (VO2max) is a powerful prognostic marker, and Z-score-based evaluations may improve early risk stratification.
In this prospective multicenter study, children aged 6-17 years with CKD stages 2-5 (Kidney Disease Improving Global Outcome (KDIGO)) underwent standardized cardiopulmonary exercise testing (CPET). VO2max was expressed as Z-scores using contemporary pediatric reference values. Impaired fitness was defined as VO2max Z-score < -1.64. Multivariable linear regression was used to identify independent determinants of VO2max.
Among 88 enrolled patients (mean age 12±4 years, 67% male), 77 completed a valid CPET. Mean VO2max Z-score was -1.8±2.1, corresponding to 33.5±9.2 ml/kg/min, i.e. an absolute lowering of approximately 10 mL/kg/min compared with age- and sex-matched reference values. Overall, 57% had impaired fitness. VO2max was progressively lower across higher CKD stages (P<0.001). In multivariable analysis, higher VO2max was independently associated with higher hemoglobin concentration, better pulmonary function (FEV1), better ventilatory efficiency (VE/VCO2 slope), and higher ventilatory anaerobic threshold (VAT), explaining 77% of VO2max variability.
Cardiopulmonary fitness is markedly lower in children with CKD, with a clear stage-dependent decline that is already evident at early disease stages. The magnitude of VO2max impairment is substantial and related to potentially modifiable clinical and functional factors, supporting early CPET-based screening and the development of targeted, multidisciplinary rehabilitation in pediatric CKD.
clinicaltrials.gov identifier NCT04897672 and Montpellier University Hospital Institutional Review Board (IRB 202100852).
PMID:
42485103
Bibliographic data and abstract were imported from PubMed on 23 Jul 2026.
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