Association between physical activity and mortality in end-stage kidney disease: a systematic review of observational studies

Abstract

Background End-stage Kidney Disease patients have a high mortality and hospitalization risk. The association of these outcomes with physical activity is described in the general population and in other chronic diseases. However, few studies examining this association have been completed in end-stage Kidney Disease patients, raising the need to systematically review the evidence on the association of physical activity with mortality and hospitalization in this population. Methods Electronic databases (EBSCO, Scopus and Web of Science) and hand search were performed until March 2020 for observational studies reporting the association of physical activity with mortality or hospitalization in adult end-stage Kidney Disease patients on renal replacement therapy (hemodialysis, peritoneal dialysis and kidney transplant). Methodological quality of the included studies was assessed using the Quality in Prognosis Studies tool. The review protocol was registered in PROSPERO (CRD42020155591). Results Eleven studies were included: six in hemodialysis, three in kidney transplant, and two in hemodialysis and peritoneal dialysis patients. Physical activity was self-reported, except in one study that used accelerometers. All-cause mortality was addressed in all studies and cardiovascular mortality in three studies. Nine studies reported a significant reduction in all-cause mortality with increased levels of physical activity. Evidence of a dose-response relationship was found. For cardiovascular mortality, a significant reduction was observed in two of the three studies. Only one study investigated the association of physical activity with hospitalization. Conclusions Higher physical activity was associated with reduced mortality in end-stage Kidney Disease patients. Future studies using objective physical activity measures could strengthen these findings. The association of physical activity with hospitalization should be explored in future investigations.

The Effect of Nutrition and Exercise on Body Composition, Exercise Capacity, and Physical Functioning in Advanced CKD Patients

“…In general, the more severely reduced the glomerular filtration rate (GFR), the more physically inactive [ 1 , 43 , 50 ] and the more severely impaired the exercise capacity of many CKD patients [ 37 , 46 ]. These matters are considered to be of major clinical importance because physical dysfunction, muscle atrophy, and reduced muscle strength are all associated with poor quality of life and increased morbidity and mortality in CKD and ESRD patients [ 4 , 6 , 51 , 52 , 53 , 54 , 55 ].…”

The Role of Physical Activity and Mortality in Hemodialysis Patients: A Review

“…Substantial prospective observational studies of HD patients support the same conclusion ( Table 1 ). In a recent meta-analysis of nine cohort studies, greatest vs. lowest physical activity levels was associated with a 14% lower risk of all-cause mortality (hazard ratio (HR) = 0.86, 95% confidence interval ( CI ), 0.83 to 0.89; P = 0.003) in patients with end-stage renal disease ( 23 ). Data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) revealed that mortality risk was lower among patients who engage in regular physical activity (HR = 0.73, 95% CI , 0.69 to 0.78; P < 0.001) ( 24 ).…”

Obesity, Weight Loss, Lifestyle Interventions, and Autosomal Dominant Polycystic Kidney Disease

“…Collectively, large epidemiological studies and several randomized controlled trials, including both the general population and those with CKD, provide evidence that increased physical activity can reduce the risk of mortality [ 117 – 120 ]. The recommendations for frequency, intensity, time, and type of exercise are still being developed for those with CKD [ 121 ].…”