DIET-HD Study: Physical activity reduces cardiovascular mortality in patients on dialysis
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Patients on maintenance hemodialysis who engaged in occasional or frequent physical activity were less likely to die from cardiovascular causes compared with those who reported being physically inactive.
The findings are based on a sub-analysis of data from the Dietary Intake, Death and Hospitalization in Adult with ESKD Treated with Hemodialysis (DIET-HD) study, which was a multinational, prospective, cohort study conducted in 11 countries throughout Europe and South America.
Physical activity
“Multiple trials have assessed the effects of exercise training for adults undergoing hemodialysis. While they have demonstrated positive impacts on physical fitness, physical functioning and health-related quality of life, they were of insufficient duration and lacked the necessary power to assess patient important outcomes including mortality and cardiovascular events,” Amelie Bernier-Jean, PhD, of the School of Public Health, faculty of medicine and health at The University of Sydney, and colleagues wrote. “Few cohort studies have assessed the association between physical activity and all-cause mortality among adults receiving hemodialysis treatments and have not assessed cause-specific deaths. We assessed the association between physical activity and all-cause and cause-specific mortality in a large cohort of well characterized adults undergoing hemodialysis.”
In addition to information collected as part of the initial DIET-HD study (including socio-demographic characteristics, smoking status, comorbidities, medication, blood pressure, dialysis prescription, vascular access and dietary intake), participants reported physical activity levels as “frequent” (more than once a week to daily), “occasional” (irregularly to once a week) or “inactive” (no physical activity).
“Physical activity was defined as any bodily movement resulting in energy expenditure including activities related to occupation, transportation, sports or household maintenance,” the researchers wrote.
Of the 6,147 participants who supplied information on physical activity, 47.8% reported no physical activity; 32.2% reported occasional activity; and 19.9% reported frequent activity. Bernier-Jean and colleagues noted those in the inactive group were older, more likely to be women and more likely to have diabetes.
“The Charlson Comorbidity Index was highest among the physically inactive individuals who were also less likely to have a functioning arteriovenous fistula or be waitlisted for kidney transplantation,” they wrote.
All-cause mortality, cardiovascular mortality and non-cardiovascular mortality were then considered, with researchers classifying sudden death, acute myocardial infarction, pericarditis, atherosclerotic heart disease, cardiomyopathy, cardiac arrhythmia, cardiac arrest, valvular heart disease, pulmonary edema and congestive cardiac failure as cardiovascular deaths.
During a median follow-up of 3.82 years, 2,337 participants died; 45% of deaths were attributed to cardiovascular causes.
Physical activity linked to reduction in cardiovascular mortality
Findings indicated that occasional physical activity was associated with lower all-cause mortality (adjusted hazard [aHR]=0.80), cardiovascular mortality (aHR=0.82) and non-cardiovascular mortality (aHR=0.81) compared with inactivity. While frequent physical activity did not lead to lower rates of non-cardiovascular mortality (aHR = 0.88), researchers observed an association between frequent activity and lower all-cause mortality (aHR = 0.82) and cardiovascular mortality (aHR = 0.77).
“The magnitudes of the associations with both cardiovascular and non-cardiovascular death were clinically important, and a dose-dependent association was observed with cardiovascular mortality, such that occasional activity was associated with an 18% reduction and frequent activity with a 23% reduction in cardiovascular mortality,” Bernier-Jean and colleagues wrote, adding the findings support the notion that patients on dialysis may benefit from physical activity in ways similar to the general population.
“While [the findings] suggest that increased physical activity would also lead to benefits in people receiving hemodialysis, the potential harms have not yet been assessed in this population,” the researchers wrote. “On balance, recommending some level of physical activity could be justified before definitive trials are conducted. Our results indeed suggest that even low levels of physical activities that are likely to be safe may yield significant improvement in mortality.”
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