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

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Journal of Nephrology Aims and scope Submit manuscript

Abstract

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.

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Acknowledgments

We thank the patients who participated in this study. From the Swedish side, we are indebted to Åsa Lindé for data and sample collection, and to our research staff Annika Nilsson, Anki Emmoth, Ulrika Jensen, Monica Ericsson and Ann-Christin Bragfors-Helin. From the Spanish side, we want to thank the collaboration of the whole staff at the hemodialysis unit. Gabriela Cobo benefits from a PhD scholarship from the Ecuadorian government, and the stay at Karolinska Institutet was supported by the Spanish Society of Nephrology. Patient data collection in Sweden was supported by an unrestricted grant from Amgen. This study also received support from The Swedish Medical Research Council and The Osterman and The Westman Foundations. Baxter Novum is the result of a grant from Baxter Healthcare Corporation to Karolinska Institutet.

Conflicts of interest

Gabriela Cobo: none; Paloma Gallar: none; Thiane Gama-Axelsson: none; Cristina Di Gioia: none; Abdul Rashid Qureshi: none; Rosa Camacho: none; Ana Vigil: none; Olof Heimbürger: none; Olimpia Ortega: none; Isabel Rodriguez: none; Juan Carlos Herrero: none; Peter Barany: none; Bengt Lindholm: employed by Baxter Healthcare Corporation; Peter Stenvinkel: none; Juan Jesús Carrero: none.

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Authors and Affiliations

  1. Department of Nephrology, Severo Ochoa Hospital, Leganes, Madrid, Spain

    Gabriela Cobo, Paloma Gallar, Cristina Di Gioia, Rosa Camacho, Ana Vigil, Olimpia Ortega, Isabel Rodriguez & Juan Carlos Herrero

  2. Divisions of Renal Medicine and Baxter Novum CLINTEC, Karolinska Institutet, M99 Karolinska University Hospital Huddinge, SE-14186, Stockholm, Sweden

    Thiane Gama-Axelsson, Abdul Rashid Qureshi, Olof Heimbürger, Peter Bárány, Bengt Lindholm, Peter Stenvinkel & Juan Jesús Carrero

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  1. Gabriela Cobo
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Corresponding author

Correspondence to Juan Jesús Carrero.

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Cobo, G., Gallar, P., Gama-Axelsson, T. et al. Clinical determinants of reduced physical activity in hemodialysis and peritoneal dialysis patients. J Nephrol 28, 503–510 (2015). https://doi.org/10.1007/s40620-014-0164-y

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  • DOI: https://doi.org/10.1007/s40620-014-0164-y

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