Habitual Physical Activity Measured by Accelerometer and Survival in Maintenance Hemodialysis Patients

Abstract

SummaryBackground and objectives The association between mortality and physical activity based on self-report questionnaire in hemodialysis patients has been reported previously. However, because self-report is a subjective assessment, evaluating true physical activity is difficult. This study investigated the prognostic significance of habitual physical activity on 7-year survival in a cohort of clinically stable and adequately dialyzed patients.Design, setting, participants, & measurements A total of 202 Japanese outpatients who were undergoing maintenance hemodialysis three times per week at the hemodialysis center of Sagami Junkanki Clinic (Japan) from October 2002 to February 2012 were followed for up to 7 years. Physical activity was evaluated using an accelerometer at study entry and is expressed as the amount of time a patient engaged in physical activity on nondialysis days. Cox proportional hazard regression was used to assess the contribution of habitual physical activity to all-cause mortality.Results The median patient age was 64 (25th, 75th percentiles, 57, 72) years, 52.0% of the patients were women, and the median time on hemodialysis was 40.0 (25th, 75th percentiles, 16.8, 119.3) months at baseline. During a median follow-up of 45 months, 34 patients died. On multivariable analysis, the hazard ratio for all-cause mortality per 10 min/d increase in physical activity was 0.78 (95% confidence interval, 0.66-0.92; P=0.002).Conclusions Engaging in habitual physical activity among outpatients undergoing maintenance hemodialysis was associated with decreased mortality risk.

Evaluating the association between walking speed and reduced cardio-cerebrovascular events in hemodialysis patients: a 7-year cohort study

“…Several other studies indicated that high levels of physical activity were associated with a decreased risk of subsequent cardio-cerebrovascular events in healthy older adults [20,21]. We found in previous studies that a lower level of habitual physical activity is an independent risk factor for all-cause mortality and is closely associated with slow MWS in maintenance HD patients [13,22]. Several previous studies also revealed that HD patients who increased their level of physical activity were able to improve risk factors for cardiocerebrovascular disease, such as hypertension, arterial stiffness, inflammatory reaction, vascular endothelial function, high levels of plasma triglycerides and low levels of high-density lipoprotein cholesterol, dysfunction of the cardiac autonomic nervous system, and reduced maximal oxygen consumption [22][23][24].…”

Functional Cardiovascular Reserve Predicts Survival Pre-Kidney and Post-Kidney Transplantation

“…9,25 Several studies have reported the association of habitual physical inactivity in CKD patients with a high mortality risk. 6,[26][27][28] Despite the finding that the death rate was greater in inactive individuals compared with those with increased physical activity, no studies had yet recognized that physical inactivity in a CKD cohort could be related to exercise intolerance due to pathologically impaired cardiovascular reserve. In this study, we utilized a maximal individualized ramping exercise protocol because submaximal CPET-derived indices of cardiovascular reserve may be further limited by an individual's determination or muscle deconditioning.…”

Associations of Self-Reported Physical Activity Types and Levels with Quality of Life, Depression Symptoms, and Mortality in Hemodialysis Patients

“…Previous studies in patients with CKD and patients on maintenance hemodialysis (MHD) have shown associations of physical activity with improved outcomes (10)(11)(12)(13)(14)(15)(16)(17)(18). However, it is uncertain whether the benefits of types and levels of physical activity apply for different outcomes, such as health-related quality of life (HRQOL), depression, and survival, in patients on MHD with diverse clinical characteristics.…”