Higher levels of physical activity were associated with a one-half reduction in risk of death among patients with advanced chronic kidney disease (CKD) in a recent study
The prospective study included 579 adults with stage 4 to 5 CKD treated at four Canadian multi-disciplinary kidney health clinics between 2012 and 2018. Patients were not receiving kidney replacement therapy at baseline. The study was published in the American Journal of Kidney Diseases.
Physical activity was assessed using the Physical Activity Scale for the Elderly (PASE) questionnaire, which addresses occupational, household, and leisure activities over the past week. Based on their PASE scores, patients were classified as having low, light, or moderate-to-high physical activity. Physical activity level was analyzed for associations with all-cause mortality, progression to kidney failure, and risk of falls. The researchers adjusted for age, sex, and other medical conditions or risk factors.
The median age of those studied was 72 years and 59% of patients were men. Physical activity was classified as low in 24.5% of patients, light in 34.2%, and moderate to high in 41.3%. Patients with moderate-to-high physical activity were younger and had lower rates of comorbid conditions. Physical activity level was strongly related to physical functioning.
Over about 8 years of follow-up, approximately 20% of patients died, 35% progressed to dialysis, and 22% had a fall. On adjustment for age, sex, and comorbidity, moderate-to-high of physical activity was associated with substantially lower mortality, with a hazard ratio 0.48.
Physical activity was not associated with progression to kidney failure or to a risk of falls. Previous falls were the only significant risk factor for future falls.
CKD is characterized by declining physical function and physical activity. Low physical activity in CKD patients is associated with adverse outcomes, including poor quality of life and increased cardiovascular risk, and with worsening of CKD. There are few data on outcomes associated with physical activity in patients with advanced CKD who have not yet started dialysis.
The researchers found about a 50% reduction in all-cause mortality for advanced CKD patients with a moderate-to-high level of physical activity. Additionally, physical activity appeared to be unrelated to progression to kidney failure or to future falls. The risk of progressive CKD in this group of patients may be “relatively non-modifiable,” the researchers suggest. “Interventional studies are now needed to investigate the effect of maintaining or increasing physical activity in the CKD population,” they state.
Rampersad C , et al. Association of physical activity and poor health outcomes in patients with advanced CKD. Am J Kidney Dis [published online ahead of print February 10, 2021]. doi: 10.1053/j.ajkd.2020.12.018; https://www.ajkd.org/article/S0272-6386(21)00082-2/fulltext
