Abstract
BACKGROUND: Cardiopulmonary exercise testing (CPET) is an emerging tool in nephrology that has garnered significant interest among clinicians and investigators. SUMMARY: CPET technology enables the user to accurately assess cardiovascular functional capacity using an integrative approach, to identify multi-organ reserve capacities and interrogate pathophysiological mechanisms underpinning impaired exercise tolerance in patients with chronic kidney disease (CKD). These capabilities provide rationale for accumulating studies exploring the use of this existing technology for new applications in nephrology and to solve current clinical practice barriers. Examples of current clinical interest areas include its potential to help transform diagnostic approaches to cardiovascular complications in patients with CKD, to offer superior cardiovascular risk stratification and to provide a solution to current limitations of traditional resting endpoints in cardiorenal clinical trials. KEY MESSAGES: This article reviews the foundational principles, methodologic, and operational implementation of CPET in patients with CKD and those on dialysis.