Low Physical Activity and Risk of Cardiovascular and All-Cause Mortality in Renal Transplant Recipients

Zelle, Dorien M.; Corpeleijn, Eva; Stolk, Ronald P.; Greef, M.H.G. de; Gans, Rijk O. B.; Heide, Jaap J. Homan van der; Navis, Gerjan; Bakker, Stephan J. L.

doi:10.2215/cjn.03340410

Cited by 131 publications

(128 citation statements)

References 48 publications

(43 reference statements)

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“…Lower scores for physical activity were associated with all-cause mortality, as well as death with a functioning graft. These data are consistent with data from other studies that demonstrate a relationship between physical functioning and outcomes after transplant (13,14). However, there is no consensus on what constitutes adequate physical functioning.…”

supporting

confidence: 88%

Ionizing Radiation During Pretransplant Evaluation

Adey

2013

Clinical Journal of the American Society of Nephrology

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supporting

confidence: 88%

Ionizing Radiation During Pretransplant Evaluation

Adey

2013

Clinical Journal of the American Society of Nephrology

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“…Recently, Zelle et al [8] using a different PA questionnaire found a strong association between low PA and all-cause mortality in prevalent KTRs who were transplanted at least a year earlier.…”

Section: Discussionmentioning

confidence: 99%

“…Since PASE scores were not normally distributed, we created tertiles of PA, stratified by gender as per other reports [8]. We determined associations between PASE tertile and other participant attributes using ANOVA for continuous variables or χ 2 for categorical variables.…”

Section: Methodsmentioning

confidence: 99%

Pretransplant Physical Activity Predicts All-Cause Mortality in Kidney Transplant Recipients

Rosas

Reese²,

Huan

et al. 2011

Am J Nephrol

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Background: Low physical activity (PA) has been associated with higher rates of cardiovascular disease (CVD) and mortality in the general population. Despite the benefits of kidney transplantation, kidney transplant recipients (KTRs) remain at elevated risk for CVD and mortality compared to individuals without kidney disease. Methods: A prospective cohort of 507 adult KTRs from three academic centers completed the Physical Activity Scale for the Elderly (PASE) at transplantation. PASE scores were divided into tertiles. Results: PA was lower with older age, history of CVD, smoking, and diabetes. During the median 8-year follow-up period, 128 individuals died, among whom 101 had a functioning allograft. In multivariable Cox regression for all-cause mortality, greater PA was strongly associated with better survival (HR: 0.52 for most active vs. inactive tertiles, 95% CI: 0.31–0.87, p = 0.01). Secondary analyses, in which (1) death with a functioning graft was the primary outcome, and (2) PASE scores were converted to the metabolic equivalent of task, revealed similar results. We did not find an association between change of PA after transplantation and mortality. Conclusions: PA at the time of kidney transplantation is a strong predictor of all-cause mortality and death with graft function. Evaluation of PA level among kidney transplant candidates may be a useful method to risk-stratify patients for survival after kidney transplantation. Kidney transplant candidates and recipients should also be encouraged to be physically active.

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“…Following a kidney transplant, RTRs spontaneously increase their activity levels and this peaks at oneyear posttransplantation despite an initial decrease in the first month postoperatively [110] . Those who are more physically active have a reduced CV risk [111] and exercise programmes designed for RTRs have been shown to improve a number of physiological and psychological parameters [112,113] . However, blood pressure has been measured in several studies and there are no overall significant effects of exercise [114,115] .…”

Section: Lifestyle Factorsmentioning

confidence: 99%

Cardiovascular risk factors following renal transplant

Neale

Smith

2015

WJT

117

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Kidney transplantation is the gold-standard treatment for many patients with end-stage renal disease. Renal transplant recipients (RTRs) remain at an increased risk of fatal and non-fatal cardiovascular (CV) events compared to the general population, although rates are lower than those patients on maintenance haemodialysis. Death with a functioning graft is most commonly due to cardiovascular disease (CVD) and therefore this remains an important therapeutic target to prevent graft failure. Conventional CV risk factors such as diabetes, hypertension and renal dysfunction remain a major influence on CVD in RTRs. However it is now recognised that the morbidity and mortality from CVD are not entirely accounted for by these traditional risk-factors. Immunosuppression medications exert a deleterious effect on many of these well-recognised contributors to CVD and are known to exacerbate the probability of developing diabetes, graft dysfunction and hypertension which can all lead on to CVD. Nontraditional CV risk factors such as inflammation and anaemia have been strongly linked to increased CV events in RTRs and should be considered alongside those which are classified as conventional. This review summarises what is known about risk-factors for CVD in RTRs and how, through identification of those which are modifiable, outcomes can be improved. The overall CV risk in RTRs is likely to be multifactorial and a complex interaction between the multiple traditional and non-traditional factors; further studies are required to determine how these may be modified to enhance survival and quality of life in this unique population. Core tip: Cardiovascular disease (CVD) is the leading cause of death and disability in patients following a renal transplant. Identification of risk factors for CVD and strategies for their improvement are required in order to prevent graft failure in this complex patient

show abstract

Low Physical Activity and Risk of Cardiovascular and All-Cause Mortality in Renal Transplant Recipients

Cited by 131 publications

References 48 publications

Ionizing Radiation During Pretransplant Evaluation

Ionizing Radiation During Pretransplant Evaluation

Pretransplant Physical Activity Predicts All-Cause Mortality in Kidney Transplant Recipients

Cardiovascular risk factors following renal transplant

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