Energy expenditure estimates in chronic kidney disease using a novel physical activity questionnaire

Abstract

Background Physical activity (PA) levels are low in patients with advanced chronic kidney disease (CKD), and associate with increased morbidity and mortality. Reliable tools to assess PA in CKD are scarce. We aimed to develop and validate a novel PA questionnaire for use in CKD (CKD-PAQ). Methods In phase 1, a prototype questionnaire was developed based on the validated Recent Physical Activity Questionnaire (RPAQ). Structured feedback on item relevance and clarity was obtained from 40 CKD patients. In phase 2, the questionnaire was refined in 3 iterations in a total of 226 CKD patients against 7-day accelerometer and RPAQ measurements. In phase 3, the definitive CKD-PAQ was compared with RPAQ in 523 CKD patients. Results In the final iteration of phase 2, CKD-PAQ data were compared to accelerometer-derived and RPAQ data in 60 patients. Mean daily Metabolic Equivalent of Task (MET) and Total Energy Expenditure (TEE) levels were similar by all methods. Intraclass correlation coefficients showed fair agreement (MET) and good (TEE) between accelerometry and both CKD-PAQ and RPAQ. Agreement between questionnaires was excellent. For mean daily MET bias was 0.035 (SD 0.312) for CKD-PAQ and 0.018 (SD 0.326) for RPAQ. For TEE bias was 91 (SD 518) for CKD-PAQ and 44 (SD 548) kcal for RPAQ. Limits of agreement were wide for both parameters, with less dispersion of CKD-PAQ values. In phase 3, agreement between questionnaires was good (MET) and excellent (TEE). Bias of CKD-PAQ-derived mean daily MET from RPAQ-derived values was 0.031 (SD 0.193) with 95% limits of agreement -0.346 to 0.409. Corresponding values for TEE were 48 (SD 325) and -588 to 685 kcal/day. CKD-PAQ appeared to improve discrimination between low activity groups. Conclusions CKD-PAQ performs comparably to RPAQ though is shorter, easier to complete, may better capture low level activity and improve discrimination between low-activity groups.

Frailty, appendicular lean mass, osteoporosis and osteosarcopenia in peritoneal dialysis patients

“…Changes in the demographics of the dialysis population, with increasing numbers of older patients, lead to a more complex pattern of chronic kidney disease mineral bone disorder (CKD-MBD) due to varying amounts of osteoporosis and renal osteodystrophy [3,4]. Muscle mass declines with age, but dialysis patients are at greater risk of muscle loss, more so than that which would be expected with age alone, often termed sarcopenia [5], and the combination with frailty [6] and reduced physical activity [7], leads to higher risks for both falls and bone fractures [8].…”

Characteristics of Frailty in Haemodialysis Patients

“…As with any observational study, there are a number of considerations. Patient physical activity was self-reported using validated questionnaires ( Ainsworth et al, 2011 ; Vilar et al, 2020 ; Sridharan et al, 2022 ). The frailty CFS scores were assessed by the dialysis nursing staff, who were blinded to bioimpedance and muscle strength measurements.…”

“…We reviewed body composition and muscle strength in patients with CKD established on regular outpatient HD who had measurements of active energy expenditure (AEE) based on patient self-reported physical activity (Ainsworth et al, 2013, Vilar et al, 2021, Sridharan et al, 2022 ). Body composition, including, skeletal lean muscle mass (SLM) and appendicular lean mass (ALM) was measured post mid-week dialysis by multifrequency segmental bio-impedance (MFBIA) (In Body S720, Seoul, South Korea), using a standardised protocol ( Fürstenberg & Davenport, 2011 ), and indexed for height.…”

Determinants of active energy expenditure in haemodialysis patients

“…We compared body composition and upper arm strength in prevalent haemodialysis patients, who had completed two self‐reported physical patient activity questionnaires. The standard recent physical activity questionnaire (RPAQ), and a shorter questionnaire developed for patients with chronic kidney disease (CKD‐PAQ) (Sridharan et al, 2021). Questionnaires have previously been validated in kidney dialysis patients measuring physical activity with double labelled water and accelerometers.…”

“…All patients signed informed consent for the RPAQ and CKD‐PAQ study (Sridharan et al, 2021), which had been reviewed and approved by the United Kingdom (UK) national ethics committee (Hampstead/London), reference number 15/LO/0315.…”