Clinical determinants of reduced physical activity in hemodialysis and peritoneal dialysis patients

• Published in: Journal of nephrology Vol. 28; no. 4; pp. 503 - 510
• Main Authors: Cobo, Gabriela, Gallar, Paloma, Gama-Axelsson, Thiane, Di Gioia, Cristina, Qureshi, Abdul Rashid, Camacho, Rosa, Vigil, Ana, Heimbürger, Olof, Ortega, Olimpia, Rodriguez, Isabel, Herrero, Juan Carlos, Bárány, Peter, Lindholm, Bengt, Stenvinkel, Peter, Carrero, Juan Jesús
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2015
• Subjects: Actigraphy - instrumentation; Age Factors; Aged; Chi-Square Distribution; Comorbidity; Cross-Sectional Studies; Female; Humans; Logistic Models; Male; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Middle Aged; Motor Activity; Multivariate Analysis; Nephrology; Nutritional Status; Odds Ratio; Original Article; Peritoneal Dialysis - adverse effects; Renal Dialysis - adverse effects; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - physiopathology; Renal Insufficiency, Chronic - therapy; Risk Factors; Sedentary Lifestyle; Spain - epidemiology; Sweden - epidemiology; Time Factors; Treatment Outcome; Urology; Sweden; Spain; Dialysis; Pedometer; Physical activity; Body composition
• ISSN: 1121-8428; 1724-6059; 1724-6059
• DOI: 10.1007/s40620-014-0164-y

Objectives The phenotype associated to reduced physical activity (PA) in dialysis patients is poorly documented. We here evaluate weekly PA in two independent cohorts. Methods Cross-sectional study with PA assessed by the number of steps/day measured by pedometer in two cohorts of prevalent dialysis patients: (1) peritoneal dialysis (PD) patients (n = 64; 62 ± 14 years; 70 % men) from Stockholm, Sweden using the pedometer for 7 consecutive days; (2) hemodialysis (HD) patients (n = 78; 63 ± 12 years; 65 % men) from a single center in Madrid, Spain using the pedometer for 6 consecutive days: 2 HD days, 2 non-HD midweek days and 2 non-HD weekend days. In both cohorts, comorbidities, body composition, nutritional status, and related biomarkers were assessed. Cohorts were not merged; instead data were analyzed separately serving as reciprocal replication analyses. Results Most patients (63 % of PD and 71 % of HD) were considered sedentary (<5,000 steps/day). PD patients had on average 4,839 ± 3,313 steps/day. HD patients had 3,767 ± 3,370 steps/day on HD-free days, but fewer steps/day on HD days (2,274 ± 2,048 steps/day; p < 0.0001). In both cohorts, and across increasing PA tertiles, patients were younger and had less comorbidities. Higher PA was also accompanied by better nutritional status (depicted by albumin, pre-albumin, creatinine and normalized protein catabolic rate in HD, and by albumin and subjective global assessment [SGA] in PD), higher lean body mass, and lower fat body mass (bioimpedance and/or dual-energy X-ray absorptiometry [DEXA]). Higher levels of PA were accompanied by lower levels of C-reactive protein in PD. Age and lean body mass were the strongest multivariate predictors of PA in both cohorts. Conclusion There is a high prevalence of sedentary behavior in dialysis patients. Better physical activity was consistently associated with younger age, lower presence of comorbidities and better nutritional status. Pedometers represent a simple and inexpensive tool to objectively evaluate physical activity in this patient population.