Dose–response effects of physical activity on all-cause mortality and major cardiorenal outcomes in chronic kidney disease

Abstract

Aims Physical activity has a protective effect against mortality and cardiovascular events in chronic kidney disease (CKD) patients. Nonetheless, how different levels of physical activity affect the health benefits in CKD remains unclear. This study aimed to investigate the dose–response effects of physical activity on mortality and major cardiorenal events in CKD. Methods and results We evaluated a longitudinal cohort of 4508 Taiwanese CKD patients between 2004 and 2017. Physical activity was assessed by the NHANES questionnaire and quantified in metabolic equivalent-hours per week (MET-hour/week). Patients were categorized into highly active (≥7.5 MET-h/week), low-active (0.1 to <7.5 MET-h/week), or inactive (0 MET-h/week) groups. Cox regression and restricted cubic spline models were utilized to explore the association between physical activity and the risks of study outcomes, including all-cause mortality, end-stage renal disease (ESRD), and major adverse cardiovascular events (MACE, a composite of cardiovascular death, myocardial infarction, ischaemic stroke, and hospitalized heart failure). During a median follow-up of 686 days, 739 death, 1059 ESRD, and 521 MACE events occurred. Highly active group had the lowest chance of all study outcomes, followed by low-active and inactive groups (P < 0.001). Multivariable Cox regression showed that only highly active group was independently associated with lower risks for all-cause mortality [hazard ratio (HR) 0.62; 95% confidence interval (CI) 0.53–0.74], ESRD (HR 0.83, 95% CI 0.72–0.96), and MACE (HR 0.63, 95% CI 0.51–0.76) compared to the inactive group. The risks of MACE did not further decrease once physical activity surpassed 15 MET-h/week, indicating a U-shaped association. The results were consistent in the subgroup and sensitivity analyses. Conclusion Physical activity of 7.5 to <15 MET-h/week is associated with lower risks of adverse cardiorenal outcomes and should be integrated into the care of CKD.

Effects and Clinical Value of Peritoneal Dialysis on Water and Water Balance, Adverse Reactions, Quality of Life, and Clinical Prognosis in Patients with Decompensated Chronic Nephropathy: A Systematic Review and Meta-Analysis

“…Peritoneal dialysis was first translated into Chinese in 1960 and did not enter the Chinese market until the late 1990s [ 14 , 15 ]. In many countries, the prognosis of PD patients is equal to or better than that of HD [ 16 , 17 ]. Based on this, this study focused on the effect of peritoneal dialysis compared with hemodialysis on renal function and quality of life in patients with end-stage renal disease to provide evidence-based medicine for patients with end-stage renal disease to choose peritoneal dialysis or hemodialysis treatment.…”

Therapeutic effects of exercise interventions for patients with chronic kidney disease: an umbrella review of systematic reviews and meta-analyses

“…A recent cohort study found that 7.5–15 metabolic equivalent hours per week (MET-h/week) was associated with the lowest risk of cardiovascular events. 58 Regrettably, the benefit of exercise on cardiovascular risk factors cannot be determined because there are an insufficient number of conclusive studies that assess exercise effects on overall cardiovascular health. In a systematic review by Heiwe et al , a meta-analysis including two trials found that exercise improved cardiovascular function in patients with CKD, as reflected in the SD of all normal RR intervals and left ventricular mass index.…”

“…However, the dose effects of exercise in the context of the cardiovascular health of patients with CKD should be considered. A recent cohort study found that 7.5–15 metabolic equivalent hours per week (MET-h/week) was associated with the lowest risk of cardiovascular events 58. Regrettably, the benefit of exercise on cardiovascular risk factors cannot be determined because there are an insufficient number of conclusive studies that assess exercise effects on overall cardiovascular health.…”

Trends in Adherence to Recommended Physical Activity and Its Association with Mortality and Disease Progression among US Adults with Chronic Kidney Disease

“…Variables previously shown to be associated with CKD and mortality were included as covariates [ 16 , 17 , 18 ]. The demographic and health-related information was collected by standardized questionnaires.…”