Effectiveness and utilization of cardiac rehabilitation among people with chronic kidney disease

Abstract Introduction Cardiac rehabilitation (CR) is a proven therapy for reducing cardiovascular death and hospitalization. Whether CR participation is associated with improved outcomes in people with CKD is unknown. Methods We obtained data on all adult patients in Calgary, Alberta, Canada with angiographically proven coronary artery disease from 1996-2016 referred to CR from The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease and TotalCardiologyTM Rehabilitation. An eGFR Results Of 23,215 patients referred to CR, 12,084 were eligible for inclusion. Participants with CKD (N=1,322) were older, had more co-morbidity, lower exercise capacity on graded treadmill testing, and took longer to be referred and to start CR than those without CKD. CKD predicted not starting CR: odds ratio 0.73 (95% CI 0.64, 0.83). Over a median one year follow up, there were 146 deaths, 40 (0.3%) CKD and 106 (1.0%) no CKD. Similar to those without CKD, the risk of death was lower in CR completers, hazard ratio 0.24 (95% 0.06, 0.91) and starters 0.56 (95% CI 0.29, 1.10) with CKD. Conclusion CR participation was associated with comparable benefits in people with moderate CKD as those without who survived to CR. Lower rates of CR attendance in this high-risk population suggest that strategies to increase CR utilization are needed.