Physical activity levels on dialysis, non-dialysis days may help predict mortality
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Patients who engaged in higher levels of physical activity on both hemodialysis and non-hemodialysis days had a lower risk for cardiovascular hospitalizations and mortality, research published in the Journal of Renal Nutrition showed.
On the other hand, patients who had higher physical activity levels on hemodialysis days but lower activity levels on non-hemodialysis days (and vice versa) had an increased risk for the two clinical outcomes.
The findings prompted Shohei Yamamoto, PT, MSc, of Kitasato University Graduate School of Medical Sciences, and colleagues to suggest daily physical activity — as measured by the number of steps taken — may be useful in risk assessments for this patient population.
“Previous cohort studies on patients undergoing [hemodialysis] HD have shown associations between higher [physical activity] PA levels and decreased mortality risk,” the researchers wrote. “In those studies, PA was assessed during leisure time or on non-HD days; however, they have not analyzed PA levels separately on HD days and non-HD days.”
For this retrospective cohort study, Yamamoto and colleagues enrolled 512 patients with end-stage kidney disease who were undergoing hemodialysis treatments at least three times weekly for at least 3 months.
Patients were categorized into one of two groups based on physical activity level, which was determined by the median number of steps performed on hemodialysis (median number of steps per day was 2,371), and non-hemodialysis days (median number of steps per day was 3,752 steps).
During a median follow-up of 3.4 years, a total of 136 deaths and 414 cardiovascular hospitalizations occurred.
Findings indicated higher physical activity levels on hemodialysis and non-hemodialysis days were associated with lower mortality risk (hazard ratios of 0.59 and 0.84, respectively).
In addition, Yamamoto and colleagues observed that patients who engaged in more physical activity on hemodialysis days and less on non-hemodialysis days or less physical activity on hemodialysis days and more on non-hemodialysis days had a greater risk for mortality than those who engaged in more physical activity on all days (HRs of 1.20 and 1.82, respectively). Patients who had lower physical activity levels on all days also were at an increased mortality risk compared with those who had higher levels (HR = 1.83).
Findings were similar for cardiovascular hospitalizations, according to researchers.
“Our results suggested that evaluating PA levels separately on HD days and non-HD days is a useful management strategy for prognostic stratification of patients undergoing HD,” Yamamoto and colleagues concluded.
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