Continuous Long-Term Physical Activity Monitoring in Hemodialysis Patients

Abstract

Background: Physical inactivity is common in patients receiving hemodialysis, but activity patterns throughout the day and in relation to dialysis are largely unknown. This knowledge gap can be addressed by long-term, continuous activity monitoring, but this has not been attempted and may not be acceptable to dialysis patients. Methods: Ambulatory patients with end-stage kidney disease receiving thrice-weekly hemodialysis wore commercially available wrist-worn activity monitors for 6 months. Step counts were collected every 15 minutes and were linked to dialysis treatments. Physical function was assessed using the Short Physical Performance Battery (SPPB). Fast time to recovery from dialysis was defined as ≤2 hours. Mixed effects models were created to estimate step counts over time. Results: Of 52 patients enrolled, 48 were included in the final cohort. The mean age was 60 years, and 75% were Black or Hispanic. Comorbidity burden was high, 38% were transported to and from dialysis by paratransit, and 79% had SPPB <10. Median accelerometer use (199 days) and adherence (95%) were high. 42 patients (of 43 responders) reported wearing the accelerometer every day, and few barriers to adherence were noted. Step counts were lower on dialysis days (3991 (95% CI 3187-4796) vs. 4561 (95% CI 3757-5365)), but step count intensity was significantly higher during the hour immediately following dialysis than during the corresponding time on non-dialysis days (188 steps/hour increase (95% CI 171-205)); these levels were the highest noted at any time. Post-dialysis increases were more pronounced among patients with fast recovery time (225 (95% CI 203-248) vs. 134 (95% CI 107-161) steps/hour) or those with SPPB≥7. Estimates were unchanged after adjustment for demographics, diabetes status, and ultrafiltration rate. Conclusions: Long-term, continuous monitoring of physical activity is feasible in hemodialysis patients. Highly granular data collection and analysis yielded new insights into patterns of activity following dialysis treatments.

Comparative efficacy of nine exercise methods on the prognosis in chronic kidney disease patients with hemodialysis: a systematic review and network meta-analysis

“…In contrast to healthy people, HD patients' physical quality gradually degrades [ 7 ]. According to a prior study, a lack of activity before and after dialysis will decrease the patient's exercise level [ 8 ]. Reduced levels of activity will raise the mortality risk [ 9 ].…”