Prevalence and correlates of physical activity across kidney disease stages: an observational multicentre study

Physical activity interventions in adult kidney transplant recipients: an updated systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Kidney transplant recipients (KTRs) exhibit a high prevalence of cardiovascular disease (CVD) and adverse changes in physical fitness and body composition. Post-transplant management recommends being physically active and evidence in this field is growing. The aim of this review was to update our previous systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of physical activity and exercise training interventions in KTRs.

METHODS

A comprehensive literature search between March 2021 and September 2024 identified seven additional RCTs. Therefore, this updated review and meta-analysis includes 23 RCTs. Outcomes included cardiorespiratory fitness (CRF), strength, blood pressure, body composition, heart rate, markers of dyslipidemia and kidney function, and health-related quality of life.

RESULTS

Twenty-three RCTs, including 1,139 KTRs, were included. The median intervention length was 12 weeks with participants exercising between 2 and 7×/week. Most studies used a mixture of aerobic and resistance training but reporting and intervention content was highly varied. Significant improvements were observed in CRF (V̇O2peak; +3.87 mL/kg/min, p = .0004), physical function (sit-to-stand-60; +7.72 repetitions, p = .0001), and high-density lipoprotein (HDL; +0.13 mmol/L, p = .02). Isolated studies reported improvements in strength, bone health, lean mass, and quality of life (QoL). All studies were found to have a high or moderate risk of bias.

CONCLUSIONS

Exercise training or increasing physical activity may confer several benefits in adult KTRs, especially through the improvements in CRF and HDL which have been linked to CVD risk. Despite new literature, there is still a need for long-term larger sampled RCTs and more detailed reporting of intervention details and program adherence.

Association between relative muscle strength and cardiometabolic multimorbidity in middle-aged and older Chinese adults

BACKGROUND

Relative muscle strength (RMS) serves as a valuable indicator of skeletal muscle function. As the body ages, skeletal muscle function declines gradually, leading to a range of adverse effects. Cardiometabolic multimorbidity (CMM) is a prevalent co-morbidity in middle-aged and elderly populations. However, there are few studies to investigate the association between RMS and CMM.

METHODS

This study adopted a cross-sectional design, including participants from the China Health and Retirement Longitudinal Study (CHARLS) of 2011. Appendicular skeletal muscle mass (ASM) was estimated using previously validated anthropometric equations. RMS was defined as the ratio of maximum hand grip strength (HGS) to ASM. CMM was characterized by the presence of at least two cardiometabolic disorders (cardiopathy, stroke, and diabetes), as assessed through self-reported physician diagnoses. The relationship between RMS and CMM was evaluated through multifactor logistic regression analysis.

RESULTS

A total of 9,200 participants with a mean age of 59.49 years were included in this study. Among them, 6,844 (74.4%) had no cardiometabolic disease (CMD), 2,052 (22.3%) had a single CMD, and 304 (3.3%) had cardiometabolic multimorbidity (CMM). Multifactor logistic regression was used to evaluate the relationship between them. In the initial model, there was a negative correlation between RMS and CMM. After adjusting for confounders, this association remained statistically significant. Specifically, for each additional unit increase in RMS, the risk of CMM was reduced by 40% (OR: 0.60, 95%CI: (0.45, 0.78)). Additionally, the highest RMS value group had a lower risk of CMM compared to the lowest value group (OR: 0.46, 95%CI: (0.31, 0.67)). As indicated by the restricted cubic spline plots, there was an L-shape correlation between RMS and CMM (P for nonlinear = 0.003).

CONCLUSION

The RMS, calculated based on HGS and ASM, was a potential indicator of CMM in middle-aged and elderly adults in China.

Physical activity and sedentary behavior in peritoneal dialysis patients: a comparative analysis of ActiGraph GT3X data collected via wrist and waist with placement-specific cut-points

BACKGROUND

The increasing adoption of accelerometers for the assessment of sedentary behaviour and physical activity among dialysis patients demands robust validation of these monitoring devices. This study aims to determine the comparability of wrist- versus waist-worn ActiGraph GT3X accelerometers, using placement-specific cut-points for peritoneal dialysis patients, to refine research and clinical practices.

METHODS

This was a cross-sectional study. Thirty-one participants wore two ActiGraph GT3X accelerometers, positioned on the right waist and nondominant wrist, and monitored over a seven-day period in a naturalistic setting. Data were processed with ActiLife v6.13.3 and analysed using intraclass correlation coefficients (ICC), limits of agreement, and pairwise 90% equivalence test within a ± 10% threshold.

RESULTS

The sedentary time measurements from both wrist- and waist-worn GT3X accelerometers were deemed equivalent, with high ICC values (0.98, 95% confidence intervals (CI) 0.97-0.99) and a ratio of 1.0 within the 90% CI of 0.9 to 1.0. Although agreement between accelerometers was good for classification of light-intensity activity (ICC = 0.76), the waist-worn device's estimates exceeded the equivalence criteria compared to the wrist-worn device (ratio 1.4; 90% CI 1.2-1.6). Conversely, the waist-worn device reported a significantly lower duration of moderate-to-vigorous physical activity (MVPA) than the wrist-worn device (Ln transformed ratio 0.3; 90% CI 0.1-0.4).

CONCLUSIONS

The use of placement-specific cut-points did not ensure equivalence in physical activity parameter estimates between wrist- and waist-worn ActiGraph GT3X devices. The findings underscore the necessity for consistent accelerometer placement for reliable monitoring of physical activity in peritoneal dialysis patients.

CLINICAL TRIAL NUMBER

Not applicable.

Prescribing Physical Activity and Exercise for People with CKD: A Practical Guide by the Global Renal Exercise Network

Physical activity (PA) and exercise are fundamental to optimizing and maintaining health. The evidence on the benefits of PA and exercise in people with CKD is well-established. Yet patients remain inactive, partly driven by a lack of knowledge and confidence from the healthcare providers involved in their management. A potential key element in improving PA in CKD includes better provisions around education, tools, and training resources among nephrology healthcare providers on PA recommendations, counseling, prescription, and referral to appropriate professionals for assessment, implementation, and monitoring. Much like other pharmacologic therapies, an effective prescription should be prescribed at the correct dose, strength, and frequency to the individual, titrated (and progressed) to optimize adherence and safety, and reviewed regularly to ensure maximum effectiveness. Aside from a formal prescription of exercise, many people would benefit from modest improvements in daily PA, and an emphasis on reducing sedentary behavior is likely to confer beneficial effects on outcomes. The purpose of this article is to outline the key components of successful PA and exercise prescriptions, including understanding the barriers and facilitators individuals may have, taking a PA history, and how to tailor exercise "dose" to each patient with the ultimate goal of increasing accessibility of PA for all people living with CKD. To do this, we will use worked examples to demonstrate what an exercise prescription may consist of across each of the major CKD stages.

Exercise perceptions and practices of people receiving peritoneal dialysis: An international cross-sectional survey

BACKGROUND

Low physical activity and functional impairment are prevalent and unaddressed in people receiving peritoneal dialysis (PD). Exercise has been shown to improve physical function and mental health for people with kidney disease.

METHODS

Cross-sectional descriptive survey aimed at identifying the exercise and physical activity perceptions and practice patterns of people receiving PD. The survey was developed and pretested with persons living with kidney disease, PD clinicians and exercise specialists.

RESULTS

There were 108 respondents (people receiving PD) with the majority from Canada (68%) and the United Kingdom (25%). Seventy-one per cent were engaged in physical activity two or more times per week. Most (91.8%) believed that physical activity is beneficial, and 61.7% reported healthcare provider discussion about physical activity. Perceptions regarding weightlifting restrictions varied: 76% were told not to lift weight with a maximum amount ranging from 2 kg to 45 kg. Few (28%) were instructed to drain PD fluid prior to physical activity. Mixed advice regarding swimming ability was common (44% were told they could swim and 44% were told they should not).

CONCLUSIONS

Knowledge gaps suggest that education for both healthcare providers and patients is needed regarding the practice of exercise for people living with PD. Common areas of confusion include the maximum weight a person should lift, whether exercise was safe with or without intrabdominal PD fluid in situ and whether swimming is allowed. Further research is needed to provide patients with evidence-based recommendations rather than defaulting to restricting activity.

Iron management and exercise training in individuals with chronic kidney disease: lived experiences

Background

Non-anaemic iron deficiency is highly prevalent in people living with chronic kidney disease (CKD) but is underdiagnosed and undertreated, especially in earlier stages of CKD. A multicentre trial assessing the effect of intravenous iron supplementation in iron-deficiency but not anaemic people with CKD included a qualitative sub-study that aimed to explore the patient experience and psychosocial impact of living with CKD and iron deficiency, and the experience of the therapeutic intervention (intravenous iron and exercise).

Methods

Semi-structured interviews were conducted with 23 trial participants blinded to treatment. Topics explored included experiences of living with CKD and iron deficiency, symptoms, social and leisure activities, quality of life, and participants' views and experiences of receiving the therapeutic intervention. Thematic analysis was used to identify and report themes.

Results

Six overarching themes were identified: lack of awareness of iron deficiency; overwhelming feelings of tiredness; feeling limited; balancing emotions; perceptions and experiences of therapeutic treatment received; and impact of trial participation on life participation. Trial participation, specifically the exercise training, was perceived to be beneficial, with improvements in life participation and psychological wellbeing experienced. However, there were no clear differences between treatment groups, with mixed perceptions about which therapeutic treatment was received.

Conclusions

The impact of tiredness on individuals with CKD is profound and can result in reduced vitality, impaired ability to engage in life activities and emotional conflict. Improved communication and support about psychosocial impact and management of symptoms, particularly fatigue, for people with CKD may be required, alongside effective therapeutic interventions, to improve symptom management and quality of life.

Current status and development trends in CKD with frailty research from 2000 to 2021: a bibliometric analysis

INTRODUCTION

The prevalence of chronic kidney disease (CKD) is gradually increasing in the elderly population. At the same time, frailty has become one of the research hotspots in the field of geriatrics. Bibliometric analyses help to understand the direction of a field. Therefore, this study aimed to analyze the status and emerging trends of frailty in CKD patients.

DATA AND METHODS

The Web of Science Core Collection (WoSCC) database was screened for relevant literature published between 1 January 2000 and 31 December 2021. Next, publications were analyzed for information including authors, journals, cited references, citing journals, institutions, countries and regions, high-frequency keywords and co-citations using VOSviewer, Microsoft Excel, and R software.

RESULTS

A total of 2223 articles were obtained, from which 613 relevant articles were selected based on title and abstract screening. There was an upward trend in the number of annual publications and Johansen KL was considered the most contributing author in the field. The Clinical Journal of the American Society of Nephrology was the most productive research journal. Johns Hopkins University is the most published organization. The United States is the global leader in the field and contributes the most to research. Research hotspots focus on epidemiological studies of frailty and frailty intervention.

CONCLUSIONS

This study presents a comprehensive bibliometric analysis of CKD and frailty research. Key findings highlight the current focus on early screening and assessment of frailty in CKD patients, as well as physical function interventions in frail patients.

Challenges in posttransplantation care for kidney transplant recipients: A qualitative study highlighting gaps in psychological, social and exercise support

BACKGROUND

Kidney transplantation offers meaningful health improvements compared to dialysis, yet the quality of life and life expectancy of kidney transplant recipients still lag behind those of their healthy peers. Physical inactivity and poor physical fitness are prevalent among kidney transplant recipients, affecting overall life participation.

OBJECTIVES

To explore challenges hindering life participation for kidney transplant recipients and reveal facilitators and barriers to integrating rehabilitation into their daily lives.

DESIGN

An explorative study using a qualitative method.

PARTICIPANTS

Fourteen purposively selected kidney transplant recipients.

APPROACH

Semistructured, individual interviews were conducted posttransplantation. The following topics were covered: living with chronic kidney disease, pretransplantation challenges, posttransplantation recovery, engagement in various activities, including physical activity, and the need for supervised exercise rehabilitation programmes. Interviews were recorded and transcribed verbatim, and an inductive thematic analysis approach was used.

FINDINGS

Data saturation occurred after analysing 12 interviews, revealing two main themes: the impact on life participation and the impact on physical and mental functioning. Participants expressed the need for comprehensive posttransplant care, including mental health support, family education and guidance on returning to work. Structured support in managing physical fitness, tailored to individual preferences, was also recognised as important.

CONCLUSIONS

The study underscores the necessity for a biopsychosocial approach to posttransplant care that addresses the multifaceted challenges faced by kidney transplant recipients. A multidisciplinary approach, tailored support, education and individualised exercise programmes are crucial for enhancing their overall well-being and integrating rehabilitation into their daily lives, considering both physical and psychosocial aspects.

Perceptions of healthcare providers on benefits, risks and barriers regarding intradialytic exercise among haemodialysis patients

PURPOSE

Clinical guidelines call for the inclusion of exercise interventions in every patient's dialysis session, but these recommendations are rarely adopted. Healthcare providers play a key role in this. Therefore, the aim of this study was to explore how healthcare providers perceive the benefits, risks and barriers of intradialytic exercise (IDE).

METHODS

We conducted 21 individual, semi-structured interviews with 11 nurses, 5 nephrologists, 3 training assistants and 2 managers from two dialysis centres in Slovakia. Verbatim transcripts of digitally recorded interviews were thematically analysed using MAXQDA®.

RESULTS

Participants reported the benefits of IDE as improvements in patients' physical and psychosocial functioning, independence and self-efficacy, clinical profile and quality of therapy. As risks of IDE, they most frequently reported exercise-related damage to vascular access, insufficient individualization of training and musculoskeletal injuries. The presence of psychological problems among patients was reported as a major barrier for initiating and maintaining patients' exercise. Other reported barriers included limitations in financial and personnel resources of haemodialysis care.

CONCLUSIONS

Safe and sustainable implementation of IDE, which might improve a patient's well-being, need to be prescribed in alignment with the patient's clinical profile, be delivered individually according to the patient's characteristics and requires adjustments in the available resources.

Barriers and enablers to exercise in kidney transplant recipients: Systematic review of qualitative studies

BACKGROUND

Exercise has the potential to reduce the susceptibility to comorbidity and cardiovascular disease in kidney transplant recipients. However, kidney transplant recipients report lower levels of exercise compared to the general population, prompting an investigation into the barriers and enablers to exercise in this transplant cohort.

OBJECTIVES

This systematic review aimed to explore and map the barriers and enablers to exercise in kidney transplant recipients.

METHODS

Seven electronic databases were systematically searched. Themes were synthesised and then deductively categorised using the Theoretical Domains Framework.

RESULTS

Eleven studies were included in the review. Commonly reported barriers to exercise were lack of exercise guidance (n = 9 studies), physical limitations (n = 5 studies) and a fear of harming the kidney (n = 7 studies). Enablers were a desire to return to normality (n = 5 studies), physical and mental benefits (n = 3 studies), goal setting and tracking improvements (n = 3 studies). At the local level, barriers identified by kidney transplant recipients were a lack of knowledge, fear of injuring the kidney, bad weather and physical limitations. Perceived enablers were already living an active lifestyle, mental benefits, exercise preferences and social support.

CONCLUSION

Key findings of this research were an increased demand for specific/explicit exercise information regarding type and intensity, and personalised guidance and support for kidney transplant recipients after transplantation. These findings can be used to inform the development of exercise resources and interventions for kidney transplant recipients and their health care professionals within the local community and at a greater level.

The effect of coaching on health information literacy in patients with chronic kidney disease: a randomized controlled trial

BACKGROUND

Since chronic kidney disease is highly insidious in the early stages, most diagnosed patients have already developed irreversible renal failure. There is a lack of effective implementation and standardization of health education management for patients with chronic kidney disease, and the impact of health education management on health information literacy is not yet known.

METHODS

This randomized controlled clinical trial was conducted from March 2022 to March 2023. A total of 130 patients with chronic kidney disease stage 3-4 were selected from a tertiary hospital in Zhuhai via a convenience sampling method and were then randomly assigned to intervention and control groups. The Health Information Literacy Questionnaire for Chronic Kidney Disease was used to assess the health literacy of the patients at month 0 and month 12. In addition, the renal function-related indices of the patients were measured before and after the intervention. The study adhered to SPIRIT guidelines.

RESULTS

There was no significant difference between the two groups in health information literacy, platelet count, estimated glomerular filtration rate, or albumin level. However, the intervention group showed a significant improvement in health behavioral status such as information acquisition, checkups, and physical activity. Subgroup analysis revealed that hemoglobin was significantly higher in non-employed patients than in the intervention group. There was a significant improvement in hemoglobin level after receiving health guidance in patients with intermediate education, and acquisition capacity and estimated glomerular filtration rate in the intervention group were lower than in the control group for patients with elementary education.

CONCLUSION

Receiving health coaching helped to improve self-management behaviors and hemoglobin levels of patients with stage 3-4 chronic kidney disease. Education level is an important factor influencing the effectiveness of health coaching techniques.

TRIAL REGISTRATION

This study was prospectively registered in the China Clinical Trial Registry on November 10, 2021, with registration number: ChiCTR2100053103.

Examining Self-Reported Physical Activity Levels Among Kidney Disease Patients in the United States Using the Behavioral Risk Factor Surveillance System (BRFSS) Database: A Retrospective Study

INTRODUCTION

Kidney diseases have a gradual and subtle onset, which usually results in end-stage renal disease with patients requiring renal replacement therapy. Though pharmacotherapy plays a crucial role, integrating lifestyle modifications like increased physical exercise has been associated with significant improvement in health for kidney disease patients.

AIMS

This study aims to retrospectively analyze the prevalence of self-reported physical activity among patients of kidney disease in the United States, based on demographic, socioeconomic, and healthcare access variables for the year 2021.

METHODOLOGY

Data was extracted from the Behavioral Risk Factor Surveillance System Web Enabled Analysis Tool (BRFSS WEAT) for the year 2021. Descriptive data, including numbers and percentages, was generated for each variable using cross-tabulations in the BRFSS WEAT. The data was stored in Microsoft Excel (Microsoft Corporation, Redmond, WA, USA), and statistical analysis was conducted using R version 4.3.1 (R Foundation for Statistical Computing, Vienna, Austria, https://www.R-project.org/). Statistical tests employed included the Chi-square test and Fisher's exact test to ensure robust and reliable results.

RESULTS

A total of 436,057 people participated in the BRFSS study. Out of this, 17,054 (39%) self-identified to the question "ever told you had kidney disease." In the past month, 10,004 (58.7%) participants having kidney disease were involved in physical activity, whereas 7,050 (41.3%) were not. Also, the level of physical activity among kidney disease participants was highest in ages 18-25 (75.5%), male gender (63.6%), White non-Hispanic race (59.4%), patients having advanced education (64.2%), employed (72.6%), high income (82.1%), and having routine checkup within the past one year (8,957, 58.3%).

CONCLUSION

Kidney disease patients in the United States who self-reported physical activity were found to have statistical significance between various demographic, socioeconomic, and last routine checkup variables. Prospectively, interventions must be designed to increase physical activity among kidney disease patients with a focus on high-risk demographic groups like older adults, people with lower socioeconomic status, and people who don't get regular checkups.

The use of digital health interventions to deliver prehabilitation in solid organ transplant recipients: are we there yet?

PURPOSE OF REVIEW

Prehabilitation, defined as preparing the body physically and psychologically for upcoming surgery is of increasing prominence in presurgical care. The aim of this review is to discuss the evidence base around prehabilitation in solid organ transplantation, the use of digital health as a tool to deliver these interventions, and consider future directions.

RECENT FINDINGS

Prehabilitation is of increasing interest as an adjunct to pretransplant care for individuals working up for solid organ transplantation. To date, research has shown that prehabilitation is acceptable and feasible; however, the literature base remains small. The majority of research has been delivered using in-person rehabilitation programmes, and the evidence base utilizing digital health as a means to deliver prehabilitation is limited.

SUMMARY

To date, the research evidence base in prehabilitation for solid organ transplantation is limited. Evidence in other surgical populations has demonstrated promising results, particularly in aerobic capacity, physical function and postoperative complications. Further high-quality randomized controlled clinical trials are required to strengthen the evidence base, understand how digital health can be harnessed and utilized to deliver multimodal prehabilitation with an aim to see how this may form part of routine care in the solid organ transplantation pathway.

Determinants of moderate-to-high physical activity levels in hemodialysis patients: A multicenter cross-sectional study

Moderate physical activity is related to reduced mortality in hemodialysis patients. However, most hemodialysis patients have low physical activity levels for complex reasons. This study investigated the determinants of moderate-to-high physical activity levels and whether psychosocial correlates are associated with engagement in moderate-to-high physical activity among hemodialysis patients. A cross-sectional survey was conducted with 134 hemodialysis outpatients, aged 64.7 years, in three hemodialysis centers in Taiwan. Data on sociodemographics, comorbidities, lifestyles, and psychosocial correlates, including perceived benefits, barriers, and self-efficacy of physical activity, were collected. Multiple logistic regression analyses were performed. Results showed that patients with moderate-to-high physical activity levels constituted a significantly lower proportion of current smokers and had fewer perceived physical activity barriers and higher self-efficacy of physical activity compared with those with low levels. After adjusting for potential sociodemographic covariates, current employment, nonsmoking status, and high self-efficacy of physical activity were significantly associated with moderate-to-high physical activity levels. Developing strategies to improve the self-efficacy of physical activity, support employment, and enhance anti-smoking campaigns in hemodialysis patients can help them engage in moderate-to-high levels of physical activity.

Physical activity, exercise habits and health-related quality of life in maintenance hemodialysis patients: a multicenter cross-sectional study

BACKGROUND

Although exercise has the potential to yield numerous benefits for maintenance hemodialysis patients, the relationship between physical activity, exercise habits, and health-related quality of life (HRQOL) has not been thoroughly investigated. This study aimed to characterize the physical activity, exercise habits, and HRQOL of maintenance hemodialysis patients while examining the associations between these factors.

METHODS

A convenience sampling was used to recruit 827 patients from 74 dialysis units in China. The structured questionnaire included sociodemographics, the International Physical Activity Questionnaire, exercise habits, and the Kidney Disease Quality of Life Short Form 1.3. An independent samples t-test, multivariable logistic regression analysis, and multivariable linear regression analysis were used.

RESULTS

The physical activity levels of 69% of participants were found to be below the recommendation of the World Health Organization. Despite 62.4% of participants reporting regular exercise, 73.8% reported light exercise intensity, and 92.6% engaged in walking or jogging. Participants' HRQOL was higher in the low-intensity exercise group compared with the moderate-to-hard-intensity exercise group. Moderate-to-high physical activity was associated with better HRQOL in 13 of the 19 domains and regular exercise was linked to higher HRQOL in four of the 19 domains.

CONCLUSIONS

This study identified a low level of physical activity, light exercise intensity, and walking as the primary exercise type among the participants. A significant correlation was found between higher physical activity levels, regular exercise, and better HRQOL for maintenance hemodialysis patients. It is advisable to implement strategies to enhance physical activity levels and design exercise programs for maintenance hemodialysis patients based on their real-world physical activity levels and exercise habits.

Relationships Between Various Parameters of Prolonged Sedentary Bouts and Health-Related Quality of Life (HRQOL) in Patients on Chronic Hemodialysis: A Cross-Sectional Study

BACKGROUND

Previous studies have revealed that sedentary behavior, including quantitative and qualitative parameters, was associated with health-related quality of life (HRQOL) in patients on chronic hemodialysis.

OBJECTIVE

The present study examined the relationships between various parameters of prolonged sedentary bouts on non-hemodialysis days and HRQOL in patients on chronic hemodialysis.

METHODS

 A total of 110 patients (47.2%) on chronic hemodialysis (64 men and 46 women, aged 71.4 ± 11.2 years) among 233 patients, who were outpatients at a hospital in Hiroshima prefecture, Japan, were enrolled in this cross-sectional study. Prolonged sedentary bouts were evaluated using a tri-accelerometer, i.e., sedentary behavior (minutes), median sedentary bouts (minutes), maximum sedentary bouts (minutes), sedentary bouts (bouts and minutes/bout), and prolonged sedentary bouts (≥5, ≥10, ≥30, and ≥60 minutes; bouts and minutes/bout). HRQOL was assessed using EuroQol 5-Dimension (EQ-5D).

RESULTS

 The EQ-5D score was 0.755 ± 0.216. All prolonged sedentary parameters, except for sedentary bouts (bouts), correlated with HRQOL, and higher correlation coefficients were observed between sedentary behavior (minutes) and HRQOL (r = -0.416) and between maximum sedentary bouts (minutes) and HRQOL (r = -0.436) than between other parameters. These parameters were also identified as factors affecting HRQOL, even after adjustments for confounding factors.

CONCLUSION

 In summary, sedentary behavior (minutes) and maximum sedentary bouts (minutes) on non-hemodialysis days, which may be representative of quantitative parameters for sedentary behavior, correlated with HRQOL in patients on chronic hemodialysis.

Physical activity and exercise in chronic kidney disease: consensus statements from the Physical Exercise Working Group of the Italian Society of Nephrology

The Italian Society of Nephrology has tasked its Working Group on Physical Exercise with developing a consensus statement document on physical activity and exercise in patients with chronic kidney disease (CKD). This paper consists of 16 points that were discussed, and approved using the mini-Delphi method by 15 members of the working group. Each statement is based on a comprehensive review of the literature, clinical experience, and expert opinions. Overall, the statements affirm that regular physical activity and exercise training offer numerous benefits to CKD patients, including improved physical function, enhanced cardiometabolic and neuromuscular function, cognitive benefits, and an overall improvement in quality of life. Furthermore, exercise may provide nephroprotection and reduce mortality. These advantages are observed across all CKD stages, whether on conservative therapy or kidney replacement therapy (hemodialysis or peritoneal dialysis), and in kidney transplant recipients. Moreover, when physical activity and exercise training are implemented with appropriate precautions, they are safe in CKD patients. Gradual physical activity and customized exercise programs should be tailored to the patient's exercise tolerance, potentially enhancing compliance. Clinicians are encouraged to use a series of questionnaires and tests to assess the patient's level of physical activity and performance. However, exercise and physical activity are poorly implemented in clinical practice due to many barriers related to patients and healthcare staff. Overcoming these barriers requires the proactive role of the nephrologists, who should actively incorporate exercise training and promote physical activity within routine care plans. Adopting a multidisciplinary team approach, which includes nephrologists, nurses, exercise professionals, and dietitians, is crucial for providing comprehensive rehabilitation for CKD patients. Integrating new technologies and remote check ups could further enhance the effectiveness of these interventions.

The association between physical activity and cardiovascular events, tumors and all-cause mortality in patients with maintenance hemodialysis with different nutritional status

The current research focuses on the effects of nutritional supplementation and exercise on dialysis patients, but whether physical activity (PA) can reduce the risk of adverse outcomes for patients with different nutritional status is not clear. The maintenance hemodialysis (MHD) patients were recruited from April 2021 to April 2022. The information of PA was obtained from the international physical activity questionnaire (IPAQ). The outcomes were cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor and all-cause death. We used COX proportional risk model to estimate the association between PA and the outcomes of MHD patients. Patients are classified into two groups based on geriatric nutritional risk index (GNRI) and classified by age, and we used COX proportional risk model to estimate the association of PA and outcomes in subgroups. The isotemporal substitution model (ISM) was used to estimate the effects of replacing light physical activity (LPA) with moderate physical activity (MPA) or vigorous physical activity (VPA) on risk of cardiovascular events, tumors, and all-cause death in different subgroups. The effects of PA on ankle-brachial index (ABI) and body fat content were analyzed in different IPAQ groups. A total of 241 maintenance hemodialysis patients were included, 105 peoples developed cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor and all-cause death (43.6%). The median follow-up time was 12 months. MPA reduced the risk of outcome in MHD patients or high GNRI patients (40% vs 39%).In MHD patients who was under 65 years with high GNRI, MPA reduced cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor and all-cause death by 55%.PA reduced the risk of cardiovascular event by 65%, but did not reduce the risk of tumor or all-cause death. Replacing LPA with VPA did not improve clinical outcomes. It actually increases the risk of heart failure 0.4%. MPA reduced the risk of cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor, all-cause death in MHD patients under 65 years, while VPA had no health benefit.Trial registration: ChiCTR210050998.

Factors Associated With Physical Inactivity of Recipients of a Kidney Transplant: Results From the ADHERE BRAZIL Multicenter Study

OBJECTIVE

Physical activity is recommended for recipients of a kidney transplant. However, ADHERE BRAZIL study found a high prevalence (69%) of physical inactivity in Brazilian recipients of a kidney transplant. To tackle this behavior, a broad analysis of barriers is needed. This study aimed to identify factors (patient and transplant center levels) associated with physical inactivity among recipients of a kidney transplant.

METHODS

This was a subproject of the ADHERE BRAZIL study, a cross-sectional, multicenter study of 1105 recipients of a kidney transplant from 20 kidney transplant centers. Using a multistage sampling method, patients were proportionally and randomly selected. Applying the Brief Physical Activity Assessment questionnaire, patients were classified as physically active (≥150 min/wk) or physically inactive (<150 min/wk). On the basis of an ecological model, 34 factors associated with physical inactivity were analyzed by sequential logistic regression.

RESULTS

At the patient level, physical inactivity was associated with smoking (odds ratio = 2.43; 95% CI = 0.97-6.06), obesity (odds ratio = 1.79; 95% CI = 1.26-2.55), peripheral vascular disease (odds ratio = 3.18; 95% CI = 1.20-8.42), >3 posttransplant hospitalizations (odds ratio = 1.58; 95% CI = 1.17-2.13), family income of >1 reference salary ($248.28 per month; odds ratio = 0.66; 95% CI = 0.48-0.90), and student status (odds ratio = 0.58; 95% CI = 0.37-0.92). At the center level, the correlates were having exercise physiologists in the clinical team (odds ratio = 0.54; 95% CI = 0.46-0.64) and being monitored in a teaching hospital (undergraduate students) (odds ratio = 1.47; 95% CI = 1.01-2.13).

CONCLUSIONS

This study identified factors associated with physical inactivity after kidney transplantation that may guide future multilevel behavioral change interventions for physical activity.

IMPACT

In a multicenter sample of recipients of a kidney transplant with a prevalence of physical inactivity of 69%, we found associations between this behavior and patient- and center-level factors. At the patient level, the chance of physical inactivity was positively associated with smoking, obesity, and patient morbidity (peripheral vascular disease and hospitalization events after kidney transplantation). Conversely, a high family income and a student status negatively correlated with physical inactivity. At the center level, the presence of a dedicated professional to motivate physical activity resulted in a reduced chance of physical inactivity. A broad knowledge of barriers associated with physical inactivity can allow us to identify patients at a high risk of not adhering to the recommended levels of physical activity.

Impact of physical activity on surrogate markers of cardiovascular disease in the haemodialysis population

Background

The haemodialysis (HD) population is sedentary, with substantial cardiovascular disease risk. In the general population, small increases in daily step count associate with significant reductions in cardiovascular mortality. This study explores the relationship between daily step count and surrogate markers of cardiovascular disease, including left ventricular ejection fraction (LVEF) and native T1 (a marker of diffuse myocardial fibrosis), within the HD population.

Methods

This was a post hoc analysis of the association between daily step count and metabolic equivalent of task (MET) and prognostically important cardiac magnetic resonance imaging parameters from the CYCLE-HD study (ISRCTN11299707). Unadjusted linear regression and multiple linear regression adjusted for age, body mass index, dialysis vintage, haemoglobin, hypertension and ultrafiltration volume were performed. Significant relationships were explored with natural cubic spline models with four degrees of freedom (five knots).

Results

A total of 107 participants were included [age 56.3 ± 14.1 years, 79 (73.8%) males]. The median daily step count was 2558 (interquartile range 1054-4352). There were significant associations between steps and LVEF (β = 0.292; P = .009) and steps and native T1 (β = -0.245; P = .035). Further modelling demonstrated most of the increase in LVEF occurred at up to 2000 steps/day and there was an inverse dose-response relationship between steps and native T1, with the most pronounced reduction in native T1 between ≈2500 and 6000 steps/day.

Conclusions

The results suggest an association between daily step count and parameters of cardiovascular health in the HD population. These findings support the recommendations for encouraging physical activity but are not the justification. Further research should evaluate whether a simple physical activity intervention improves cardiovascular outcomes in individuals receiving maintenance HD.

Frailty in patients on dialysis

Frailty is a condition that is frequently observed among patients undergoing dialysis. Frailty is characterized by a decline in both physiological state and cognitive state, leading to a combination of symptoms, such as weight loss, exhaustion, low physical activity level, weakness, and slow walking speed. Frail patients not only experience a poor quality of life, but also are at higher risk of hospitalization, infection, cardiovascular events, dialysis-associated complications, and death. Frailty occurs as a result of a combination and interaction of various medical issues in patients who are on dialysis. Unfortunately, frailty has no cure. To address frailty, a multifaceted approach is necessary, involving coordinated efforts from nephrologists, geriatricians, nurses, allied health practitioners, and family members. Strategies such as optimizing nutrition and chronic kidney disease-related complications, reducing polypharmacy by deprescription, personalizing dialysis prescription, and considering home-based or assisted dialysis may help slow the decline of physical function over time in subjects with frailty. This review discusses the underlying causes of frailty in patients on dialysis and examines the methods and difficulties involved in managing frailty among this group.

Feeling gutted in chronic kidney disease (CKD): Gastrointestinal disorders and therapies to improve gastrointestinal health in individuals CKD, including those undergoing dialysis

Chronic kidney disease (CKD) affects 9.1% of the population worldwide. CKD may lead to structural and functional gastrointestinal alterations, including impairment in the intestinal barrier, digestion and absorption of nutrients, motility, and changes to the gut microbiome. These changes can lead to increased gastrointestinal symptoms in people with CKD, even in early grades of kidney dysfunction. Gastrointestinal symptoms have been associated with lower quality of life and reduced nutritional status. Therefore, there has been considerable interest in improving gastrointestinal health in this clinical population. Gastrointestinal health can be influenced by lifestyle and medications, particularly in advanced grades of kidney dysfunction. Therapies focused on gastrointestinal health have been studied, including the use of probiotics, prebiotics, and synbiotics, yielding limited and conflicting results. This review summarizes the alterations in the gastrointestinal tract structure and function and provides an overview of potential nutritional interventions that kidney disease professionals can provide to improve gastrointestinal health in individuals with CKD.

Revitalizing the Gut Microbiome in Chronic Kidney Disease: A Comprehensive Exploration of the Therapeutic Potential of Physical Activity

Both physical inactivity and disruptions in the gut microbiome appear to be prevalent in patients with chronic kidney disease (CKD). Engaging in physical activity could present a novel nonpharmacological strategy for enhancing the gut microbiome and mitigating the adverse effects associated with microbial dysbiosis in individuals with CKD. This narrative review explores the underlying mechanisms through which physical activity may favorably modulate microbial health, either through direct impact on the gut or through interorgan crosstalk. Also, the development of microbial dysbiosis and its interplay with physical inactivity in patients with CKD are discussed. Mechanisms and interventions through which physical activity may restore gut homeostasis in individuals with CKD are explored.

Knowledge, attitude, and practice toward osteoporosis among patients with chronic kidney disease in Zhejiang

Patients with chronic kidney disease (CKD) are considered high-risk group for osteoporosis. However, the current understanding of their knowledge, attitude, and practice toward osteoporosis remains unclear. CKD patients were recruited from Li Huili Hospital, Ningbo Medical Center between March 2023 and June 2023. A self-designed questionnaire was used to collect the participant's demographic characteristics and knowledge, attitude, and practice toward osteoporosis. A total of 500 valid questionnaires were included in the analysis, with participants aged 51.08 ± 14.76 years. The mean scores for knowledge, attitude, and practice were 6.67 ± 3.04 (range: 0-11), 33.99 ± 3.37 (range: 10-50), and 35.29 ± 5.54 (range: 9-45), respectively. Pearson correlation analysis revealed significant positive associations between knowledge and attitude scores (r = 0.440, P < .001), knowledge and practice scores (r = 0.376, P < .001), as well as attitude and practice scores (r = 0.403, P < .001). Structural equation modeling revealed direct associations between knowledge and attitude (path coefficient = 0.488, P < .001), and between attitude and practice (path coefficient = 0.485, P < .001). The knowledge also exhibited a directly positive effect on practice (path coefficient = 0.449, P < .001). Undergoing glucocorticoid therapy (odd ratio [OR] = 2.353, 95% confidence interval [CI]: 1.022-5.418, P = .044) and osteoporosis osteoporosis (OR = 1.565, 95% CI: 1.011-2.421, P = .044) were positively associated with knowledge. Moreover, disease duration >1 year was positively associated with practice (OR = 3.643, 95% CI: 1.754-7.565, P < .001). CKD patients demonstrated moderate knowledge, neutral attitude, and moderate practice toward osteoporosis. To address the practice gaps of CKD patients toward osteoporosis, targeted educational interventions and attitude support programs can be developed.

Motion Tracking of Daily Living and Physical Activities in Health Care: Systematic Review From Designers' Perspective

BACKGROUND

Motion tracking technologies serve as crucial links between physical activities and health care insights, facilitating data acquisition essential for analyzing and intervening in physical activity. Yet, systematic methodologies for evaluating motion tracking data, especially concerning user activity recognition in health care applications, remain underreported.

OBJECTIVE

This study aims to systematically review motion tracking in daily living and physical activities, emphasizing the critical interaction among devices, users, and environments from a design perspective, and to analyze the process involved in health care application research. It intends to delineate the design and application intricacies in health care contexts, focusing on enhancing motion tracking data's accuracy and applicability for health monitoring and intervention strategies.

METHODS

Using a systematic review, this research scrutinized motion tracking data and their application in health care and wellness, examining studies from Scopus, Web of Science, EBSCO, and PubMed databases. The review used actor network theory and data-enabled design to understand the complex interplay between humans, devices, and environments within these applications.

RESULTS

Out of 1501 initially identified studies, 54 (3.66%) were included for in-depth analysis. These articles predominantly used accelerometer and gyroscope sensors (n=43, 80%) to monitor and analyze motion, demonstrating a strong preference for these technologies in capturing both dynamic and static activities. While incorporating portable devices (n=11, 20%) and multisensor configurations (n=16, 30%), the application of sensors across the body (n=15, 28%) and within physical spaces (n=17, 31%) highlights the diverse applications of motion tracking technologies in health care research. This diversity reflects the application's alignment with activity types ranging from daily movements to specialized scenarios. The results also reveal a diverse participant pool, including the general public, athletes, and specialized groups, with a focus on healthy individuals (n=31, 57%) and athletes (n=14, 26%). Despite this extensive application range, the focus primarily on laboratory-based studies (n=39, 72%) aimed at professional uses, such as precise activity identification and joint functionality assessment, emphasizes a significant challenge in translating findings from controlled environments to the dynamic conditions of everyday physical activities.

CONCLUSIONS

This study's comprehensive investigation of motion tracking technology in health care research reveals a significant gap between the methods used for data collection and their practical application in real-world scenarios. It proposes an innovative approach that includes designers in the research process, emphasizing the importance of incorporating data-enabled design framework. This ensures that motion data collection is aligned with the dynamic and varied nature of daily living and physical activities. Such integration is crucial for developing health applications that are accessible, intuitive, and tailored to meet diverse user needs. By leveraging a multidisciplinary approach that combines design, engineering, and health sciences, the research opens new pathways for enhancing the usability and effectiveness of health technologies.

Physical activity and exercise programs for kidney patients: an Italian survey of nephrology centres

BACKGROUND

Data on exercise activities in place, and on the interest for developing them in Nephrology Services in Italy is limited. To address this gap, we carried out this cross-sectional study to investigate the status of physical activity and exercise programs available in Italian Nephrology Centres. Additionally, research priorities on this topic were examined.

METHODS

We developed a 14-item electronic survey, which consisted of multiple-choice questions covering exercise training programs, physical assessment, barriers to exercise practice and to exercise programs, exercise and physical activity counselling practices, perceived exercise benefits, literature evidence, and research priorities. Data on the characteristics of the centres were also collected.

RESULTS

Sixty-two responses from Italian nephrology centres were collected. Ninety-three percent of the respondents were aware of the scientific evidence supporting the benefits of regular exercise programs for chronic kidney disease (CKD) patients. Additionally, in 75% of centres the nephrologists believed that physical activity counselling should be performed by the nephrologists. However, only 26% of centres provided exercise programs, mainly for dialysis patients, and 63% never or infrequently assessed physical activity in the context of patient management. Eighty-nine percent of centres reported barriers to implementing exercise programs, including lack of funding, institutional disinterest, patient refusal, and negative attitudes of the healthcare personnel. Forty-six research priorities related to exercise in CKD patients were suggested, with the majority focusing on impact of exercise programs and physical activity on cardiovascular, nutritional, and psychosocial outcomes.

CONCLUSION

This survey highlights the limited availability of exercise programs and physical activity evaluation in clinical practice in Italian Nephrology Centres. However, the survey also revealed a strong interest for counselling CKD patients on physical activity and implementing exercise prescriptions and interventions.

Association of daytime napping with incidence of chronic kidney disease and end-stage kidney disease: A prospective observational study

BACKGROUND AND AIMS

Few studies have examined the relationship between daytime napping and risk of kidney diseases. We aimed to investigate the association of daytime napping with the incidence of chronic kidney disease (CKD) and end-stage kidney disease (ESKD). We also examined whether sleep duration modified the association of nap with CKD or ESKD.

METHODS

We recruited 460,571 European middle- to older-aged adults without prior CKD or ESKD between March 13, 2006, and October 1, 2010, in the UK Biobank. Sleep behavior data were obtained through questionnaires administered during recruitment. The analysis of the relationship between napping and the occurrence of CKD and ESKD utilized Cox proportional hazards regression models. The modification role of sleep duration on the effect of nap on CKD and ESKD was also examined.

RESULTS

After a mean follow-up of 11.1 (standard deviation 2.2) years, we observed 28,330 incident CKD cases and 927 ESKD cases. The daytime napping was associated with incident CKD (P for trend = .004). After fully adjusted, when compared with participants who did not take nap, those in sometimes and usually nap groups had higher risk of CKD. Nevertheless, the available evidence did not support a link between daytime napping and ESKD (P for trend = .06). Simultaneously, there was insufficient evidence suggesting that sleeping duration modified the association of daytime napping with incident CKD or ESKD.

CONCLUSION

Daytime napping was associated with an increased risk of CKD. However, the absence of conclusive evidence did not indicate a connection between daytime napping and ESKD.

Development of a competency framework for the Assistant Wellbeing Practitioner (Renal) role

BACKGROUND

Many people with kidney disease experience comorbid mental health difficulties that result in worse physical health outcomes alongside greater personal, treatment and societal costs.

PROBLEM

Workforce expansion to treat comorbid mental health difficulties has focussed on psychological practitioners. This fails to capitalise on benefits arising from embedding roles to address biopsychosocial outcomes directly within the renal specialty. A competency framework to inform development and training for such a role has not been developed.

METHODS

Five-phase process to develop a competency framework for an Assistant Wellbeing Practitioner (Renal) role. Following identification of competency frameworks for roles in psychological practice, health and social care, relevant competencies were synthesised to create a draft competency framework. This framework was revised through consultation events with professionals associated with the renal specialty and Kidney Patient Involvement Network with the framework informing a competency map.

RESULTS

The competency map comprised three categories-Knowledge, Values and Principles, Core Skills and Meta-Competencies with specific competencies for an assistant practitioner role to work within the renal specialty identified. Core knowledge and skills included awareness of kidney treatments and common psychosocial difficulties, collaborative care and supporting evidence-based prevention approaches.

CONCLUSIONS

Competencies associated with the Assistant Wellbeing Practitioner (Renal) role have the potential to promote mental wellbeing, better physical health and generate social and economic benefits. The competency map can inform training and role evaluation, although addressing implementation issues associated with commissioning physical and mental healthcare is required.

Digital health interventions to promote healthy lifestyle in hemodialysis patients: an interventional pilot study

Low physical activity has been associated with poor prognosis in hemodialysis (HD) patients. Interventions to maintain healthy lifestyle in this population are important to reduce mortality. This study aimed to evaluate the effectiveness of digital health interventions (DHIs) for improving the physical activity and health-related quality of life (HRQoL) in HD patients. The 24-week prospective study enrolled 31 clinically stable HD patients. All participants were assigned home exercises and provided with wearable devices. Dietary and exercise information was uploaded to a health management platform. Suggestions about diet and exercise were provided, and a social media group was created. Physical performance testing was performed at baseline and during weeks 4, 8, 12, 16 and 24. HRQoL and nutritional status were evaluated. A total of 25 participants completed the study. After the interventions, the daily step count increased 1658 steps. The 10-time-repeated sit-to-stand test reduced by 4.4 s, the sit-to-stand transfers in 60 s increased 12 repetitions, the distance of six-minute walk test (6MWT) increased by 55.4 m. The mental health components and burden of kidney disease of the Kidney Disease Quality of Life survey, and subjective global assessment (SGA) scores improved. By Spearman correlation, the monthly step count correlated positively with 6MWT and SGA. DHIs that combined wearable devices, a health management platform, and social media could strengthen physical activity and improve the HRQoL and nutrition of maintenance HD patients. The results outline a new model to promote healthy lifestyle behaviors in HD patients.

Objectively measured daily steps as an outcome in a clinical trial of chronic kidney disease: a systematic review

BACKGROUND

Physical inactivity is prevalent among individuals with chronic kidney disease (CKD) and is linked to unfavorable outcomes. In recent years, daily steps have emerged as a prominent target for interventions in clinical trials. The present study endeavors to scrutinize the effectiveness and/or efficacy of various interventions on daily steps in patients with full-spectrum CKD.

METHODS

In December 2022, a systematic search was conducted across three databases, namely PubMed, Embase, and Web of Science, and subsequently updated in June 2023. The inclusion criteria included randomized controlled studies, quasi-experimental studies, and single-arm trials that assessed an intervention's impact on objectively measured daily steps in patients with chronic kidney disease. The Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool was used to assess the risk of bias in non-randomized controlled trials (RCT), while the Cochrane revised tool (ROB-2) was utilized for RCTs.

RESULTS

Seventeen studies were deemed eligible for inclusion in this review, with a focus on examining the efficacy and/or effectiveness of exercise training-based interventions (n = 10), daily step goal-oriented interventions (n = 4), mobile health (mHealth) interventions (n = 1), different dialysis modalities (n = 1), and a "Sit Less, Interact, Move More" intervention (n = 1). The studies exhibit variability in their characteristics and assessment tools, reflecting the findings' heterogeneity. The results indicate that increasing physical activity levels remain challenging, as only a limited number of studies demonstrated significant improvements in participants' daily step counts from baseline to endpoint.

CONCLUSION

Clinical trials with daily steps as an outcome are still lacking in the CKD population. Well-designed clinical trials that objectively assess the physical activity of CKD patients are needed.

Physical activity, chronic kidney disease, and cardiovascular risk: A study in half a million adults

OBJECTIVE

There is a growing prevalence of chronic kidney disease (CKD), a condition associated with a higher cardiovascular disease (CVD) risk. We assessed the association between self-reported physical activity (PA) and CKD and also studied whether PA attenuates CKD-associated CVD risk.

METHODS

A cohort of Spanish adults (18-64 years) participated in this nationwide study. Participants were categorized at baseline as being either inactive (performing no PA), regularly, or insufficiently active (meeting or not, respectively, international PA recommendations) and were followed for up to 5 years. The presence of CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2 ) and major CVD risk factors (diabetes, hypercholesterolemia, hypertension, obesity) was determined at baseline and at follow-up.

RESULTS

517 917 participants (44 ± 9 years, 67% male, CKD prevalence = 7%) were studied at baseline, with prospective analyses (median follow-up = 2 years, range = 2-5) in a subcohort of 264 581 individuals. Compared to physical inactivity, cross-sectional analyses at baseline showed that regular PA (odds ratio = 0.80; 95% confidence interval = 0.79-0.81), but not insufficient PA (1.02; 0.99-1.04) was associated with lower CKD prevalence. However, prospective analyses failed to confirm this association (p > 0.1). In turn, CKD was associated with a higher prevalence of hypertension (+3%) and diabetes (+5%) at baseline and with a greater incidence of hypertension at follow-up (+37%). Among those participants with CKD, regular PA was associated with a lower prevalence (-45% to -7%) and incidence (-38% to -4%) of all CVD risk factors.

CONCLUSION

Although PA might not reduce incident CKD in the middle term (~2 years), it can attenuate the CVD risk linked to this condition.

Benefits of Cardiac Rehabilitation in Cardio-Renal Patients With Heart Failure With Reduced Ejection Fraction

PURPOSE

Chronic kidney disease (CKD) is common in heart failure (HF). Chronic kidney disease often worsens the prognosis and impairs the management of patients with HF. Chronic kidney disease is frequently accompanied by sarcopenia, which limits the benefits of cardiac rehabilitation (CR). The aim of this study was to evaluate the impact of CR on cardiorespiratory fitness in HF patients with reduced ejection fraction (HFrEF) according to the CKD stage.

METHODS

We conducted a retrospective study including 567 consecutive patients with HFrEF, who underwent a 4-wk CR program, and who were evaluated by cardiorespiratory exercise test before and after the program. Patients were stratified according to their estimated glomerular filtration rate (eGFR). We performed multivariate analysis looking for factors associated with an improvement of 10% in peak oxygen uptake (V˙ o2peak ).

RESULTS

Thirty-eight percent of patients had eGFR <60 mL/min/1.73m². With decreasing eGFR, we observed deterioration in V˙ o2peak , first ventilatory threshold (VT1) and workload and an increase in brain natriuretic peptide levels at baseline. After CR, there was an improvement in V˙ O2peak (15.3 vs 17.8 mL/kg/min, P < .001), VT1 (10.5 vs 12.4 mL/kg/min, P < .001), workload (77 vs 94 W, P < .001), and brain natriuretic peptide (688 vs 488 pg/mL, P < .001). These improvements were statistically significant for all stages of CKD. In a multivariate analysis predicting factors associated with V˙ o2peak improvement, renal function did not interfere with results.

CONCLUSIONS

Cardiac rehabilitation is beneficial in patients with HFrEF with CKD regardless of CKD stage. The presence of CKD should not prevent the prescription of CR in patients with HFrEF.

The effect of exercise on vascular health in chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials

Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular disease. This increased risk cannot be fully explained by traditional risk factors such as hypertension. Endothelial dysfunction and arterial stiffness have been suggested as factors that explain some of the increased risk and are independently associated with important cardiovascular outcomes in patients with CKD. Studies in other disease populations have shown the positive effects of exercise on vascular dysfunction. The aim of this review was to determine whether exercise training interventions improve measures of vascular function and morphology in patients across the spectrum of CKD and which exercise training interventions are most efficacious. A systematic search of Medline, Embase, and the Cochrane Central Register identified 25 randomized controlled trials. Only randomized control trials using an exercise intervention with a nonexercising control group and at least one measure of vascular function or morphology were included. Participants were patients with nondialysis CKD or transplant patients or those requiring dialysis therapy. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A meta-analysis was completed for pulse wave velocity, augmentation index, and measures of endothelium-dependent vasodilation. Data from 25 studies with 872 participants showed that exercise training reduced pulse wave velocity and augmentation index but had no effect on endothelium-dependent vasodilation. Subgroup analyses suggested that exercise interventions of at least moderate intensity were more likely to be effective. Limitations included the absence of observational studies or other interventions aimed at increasing habitual physical activity. Further studies are warranted to investigate which are the most effective exercise interventions.NEW & NOTEWORTHY A thorough systematic review and meta-analysis of the effects of exercise training on measures of vascular function in patients with chronic kidney disease, including arterial stiffness and endothelial function, were conducted. Subgroup analyses investigated how differences in exercise training, according to frequency, intensity, type, and timing, have an impact on the efficacy of the intervention.

Achieving consensus on psychosocial and physical rehabilitation management for people living with kidney disease

Background

People living with chronic kidney disease (CKD) need to be able to live well with their condition. The provision of psychosocial interventions (psychological, psychiatric and social care) and physical rehabilitation management is variable across England, as well as the rest of the UK. There is a need for clear recommendations for standards of psychosocial and physical rehabilitation care for people living with CKD, and guidance for the commissioning and measurement of these services. The National Health Service (NHS) England Renal Services Transformation Programme (RSTP) supported a programme of work and modified Delphi process to address the management of psychosocial and physical rehabilitation care as part of a larger body of work to formulate a comprehensive commissioning toolkit for renal care services across England. We sought to achieve expert consensus regarding the psychosocial and physical rehabilitation management of people living with CKD in England and the rest of the UK.

Methods

A Delphi consensus method was used to gather and refine expert opinions of senior members of the kidney multi-disciplinary team (MDT) and other key stakeholders in the UK. An agreement was sought on 16 statements reflecting aspects of psychosocial and physical rehabilitation management for people living with CKD.

Results

Twenty-six expert practitioners and other key stakeholders, including lived experience representatives, participated in the process. The consensus (>80% affirmative votes) amongst the respondents for all 16 statements was high. Nine recommendation statements were discussed and refined further to be included in the final iteration of the 'Systems' section of the NHS England RSTP commissioning toolkit. These priority recommendations reflect pragmatic solutions that can be implemented in renal care and include recommendations for a holistic wellbeing assessment for all people living with CKD who are approaching dialysis, or who are at listing for kidney transplantation, which includes the use of validated measurement tools to assess the need for further intervention in psychosocial and physical rehabilitation management. It is recommended that the scores from these measurement tools be included in the NHS England Renal Data Dashboard. There was also a recommendation for referral as appropriate to NHS Talking Therapies, psychology, counselling or psychotherapy, social work or liaison psychiatry for those with identified psychosocial needs. The use of digital resources was recommended to be used in addition to face-to-face care to provide physical rehabilitation, and all healthcare professionals should be educated to recognize psychosocial and physical rehabilitation needs and refer/sign-post people with CKD to appropriate services.

Conclusion

There was high consensus amongst senior members of the kidney MDT and other key stakeholders, including those with lived experience, in the UK on all aspects of the psychosocial and physical rehabilitation management of people living with CKD. The results of this process will be used by NHS England to inform the 'Systems' section of the commissioning toolkit and data dashboard and to inform the National Standards of Care for people living with CKD.

Advancing Exercise Science for Better Health Outcomes Across the Spectrum of Chronic Kidney Disease

Despite over 30 years of evidence for improvements in physical function, physical fitness, and health-related quality of life with exercise training in individuals with chronic kidney disease, access to dedicated exercise training programs remains outside the realm of standard of care for most kidney care programs. In this review, we explore possible reasons for this by comparing approaches in other chronic diseases where exercise rehabilitation has become the standard of care, identifying enablers and factors that need to be addressed for continued growth in this area, and discussing knowledge gaps for future research. For exercise rehabilitation to be relevant to all stakeholders and become a sustainable component of kidney care, a focus on the effect of exercise on clinically relevant outcomes that are prioritized by individuals living with kidney disease, use of evidence-based implementation strategies for diverse settings and populations, and approaching exercise as a medical therapy are required.

Interventions to increase physical activity level in patients with whole spectrum chronic kidney disease: a systematic review and meta-analysis

Background: Little is known about effective interventions to increase physical activity levels in this population. This systematic review and meta-analysis evaluated the effectiveness of different interventions for physical activity levels in whole-spectrum CKD patients.Methods: In this systematic review and meta-analysis, PubMed, Embase, and Web of Science were searched from inception to December 2022, with an update in March 2023. Studies of clinical interventions based on assessing physical activity outcomes (e.g., daily steps, time spent doing physical activity) in patients with whole-spectrum CKD were included. The pooled effect size was calculated using a restricted maximum likelihood method and reported as a standardized mean difference (SMD) with 95% confidence interval (95% CI).Results: The systematic review included 2,156 participants (59.9 ± 8.7 years) from 35 studies. Interventions aimed at modifying physical activity were associated with significantly higher physical activity levels in patients with CKD (SMD = 0.22; 95% CI: 0.08 to 0.36; I2 = 55%). Exercise-based interventions and real-time step feedback increased physical activity by 0.26 (95% CI: 0.07 to 0.45; I2 = 59%) and 0.36 (95% CI: 0.12 to 0.60; I2 = 0%) standard deviations, respectively. Effect sizes did not vary by disease stage or study duration; however, there was evidence of small study or publication bias for the primary analysis.Conclusion: In this systematic review and meta-analysis, intervention strategies aimed at modifying physical activity were associated with significantly increased physical activity levels in patients with whole-spectrum CKD.

Impacts of cognition of exercise on physical activity participation in hemodialysis patients

INTRODUCTION

Physical inactivity is a strong predictor of mortality in hemodialysis patients. Although regular physical activity reduces mortality, patients remain inactive. Comparing the cognition of exercise in hemodialysis patients with different physical activity status could highlight domains where inactive people experience heightened barriers to physical activity. We therefore assessed patients' perceived benefits and barriers to exercise using a standardized way, thereby informing future exercise interventions to address these barriers experienced by inactive patients.

METHODS

ESRD patients undergoing hemodialysis were recruited and asked to complete a human activity profile, wear a pedometer for seven consecutive days, and complete the Dialysis Patient-perceived Exercise Benefits and Barriers Scale (DPEBBS). Binominal Logistic regression analysis was conducted to determine which benefits and barriers are associated with physical activity. This cross-sectional observational study was registered as NCT05189795.

RESULTS

A total of 505 patients completed the survey, most of whom were male (67.1%), with an average age of 49.69 ± 13.96 years. And 52.67-76.63% patients on HAP questionnaire were inactive. The co-benefits in active patients were improving mood and prevention of muscle wasting but did not reach significance in physical activity level. Tiredness, muscle fatigue, and lack of knowledge of exercise were common barriers to patients, and all have a significant impact on a patient's physical activity level.

CONCLUSIONS

For inactive patients, exercise during hemodialysis can not only improve physical activity but also reduce family burden. And improving physical activity is a long-term project that cannot be separated from the support of hemodialysis medical staff.

How is exercise being prescribed for patients on hemodialysis? A scoping review

BACKGROUND

Exercise is important for patients on hemodialysis, but details and descriptions on how it is prescribed are lacking. We reviewed the existing literature and described how exercise is being prescribed for patients on hemodialysis.

METHODS

A scoping review according to the JBI and PRISMA-ScR guidelines was conducted. MEDLINE, EMBASE and other databases were searched from inception until December 2021. Websites, books, and guidelines were also searched. We included evidence from patients on hemodialysis, describing exercise protocols, in all settings and designs.

RESULTS

Two hundred and eighty-five studies were included, yielding 327 exercise protocols. Aerobic (38.8%) and strength (21.4%) were the most prescribed exercise types. Exercise was mainly prescribed during dialysis (71.0%) and delivered within the first half of the session (94.6%). Although 33.3% of the exercise protocols did not report whether there was supervision or not, those that did were mostly delivered by physiotherapists (20.5%) and exercise physiologists (17.4%). The most followed exercise training principles were type (99.0%) and frequency (93.2%), whereas progression was adopted in 40.7% protocols. The most prescribed frequency and duration were three times/week (79.9%) and 30-60-min (69.2%) sessions, respectively. Exercise intensity was predominantly prescribed in moderate cut-offs (72.3%), mostly assessed by subjective methods (47.5%).

CONCLUSIONS

Aerobic and strength were the most prescribed exercise types, mainly during dialysis. Interventions were mostly supervised by physiotherapists and exercise physiologists. Future exercise protocols for patients on hemodialysis should adopt recommended exercise principles, especially with systematic progression.

The effect of a novel, digital physical activity and emotional well-being intervention on health-related quality of life in people with chronic kidney disease: trial design and baseline data from a multicentre prospective, wait-list randomised controlled trial (kidney BEAM)

BACKGROUND

Physical activity and emotional self-management has the potential to enhance health-related quality of life (HRQoL), but few people with chronic kidney disease (CKD) have access to resources and support. The Kidney BEAM trial aims to evaluate whether an evidence-based physical activity and emotional wellbeing self-management programme (Kidney BEAM) leads to improvements in HRQoL in people with CKD.

METHODS

This was a prospective, multicentre, randomised waitlist-controlled trial, with health economic analysis and nested qualitative studies. In total, three hundred and four adults with established CKD were recruited from 11 UK kidney units. Participants were randomly assigned to the intervention (Kidney BEAM) or a wait list control group (1:1). The primary outcome was the between-group difference in Kidney Disease Quality of Life (KDQoL) mental component summary score (MCS) at 12 weeks. Secondary outcomes included the KDQoL physical component summary score, kidney-specific scores, fatigue, life participation, depression and anxiety, physical function, clinical chemistry, healthcare utilisation and harms. All outcomes were measured at baseline and 12 weeks, with long-term HRQoL and adherence also collected at six months follow-up. A nested qualitative study explored experience and impact of using Kidney BEAM.

RESULTS

340 participants were randomised to Kidney BEAM (n = 173) and waiting list (n = 167) groups. There were 96 (55%) and 89 (53%) males in the intervention and waiting list groups respectively, and the mean (SD) age was 53 (14) years in both groups. Ethnicity, body mass, CKD stage, and history of diabetes and hypertension were comparable across groups. The mean (SD) of the MCS was similar in both groups, 44.7 (10.8) and 45.9 (10.6) in the intervention and waiting list groups respectively.

CONCLUSION

Results from this trial will establish whether the Kidney BEAM self management programme is a cost-effective method of enhancing mental and physical wellbeing of people with CKD.

TRIAL REGISTRATION

NCT04872933. Registered 5th May 2021.

Digital health technology to support care and improve outcomes of chronic kidney disease patients: as a case illustration, the Withings toolkit health sensing tools

Cardiovascular disease (CVD) is a major burden in dialysis-dependent chronic kidney disease (CKD5D) patients. Several factors contribute to this vulnerability including traditional risk factors such as age, gender, life style and comorbidities, and non-traditional ones as part of dialysis-induced systemic stress. In this context, it appears of utmost importance to bring a closer attention to CVD monitoring in caring for CKD5D patients to ensure early and appropriate intervention for improving their outcomes. Interestingly, new home-used, self-operated, connected medical devices offer convenient and new tools for monitoring in a fully automated and ambulatory mode CKD5D patients during the interdialytic period. Sensoring devices are installed with WiFi or Bluetooth. Some devices are also available in a cellular version such as the Withings Remote Patient Monitoring (RPM) solution. These devices analyze the data and upload the results to Withings HDS (Hybrid data security) platform servers. Data visualization can be viewed by the patient using the Withings Health Mate application on a smartphone, or with a web interface. Health Care Professionals (HCP) can also visualize patient data via the Withings web-based RPM interface. In this narrative essay, we analyze the clinical potential of pervasive wearable sensors for monitoring ambulatory dialysis patients and provide an assessment of such toolkit digital medical health devices currently available on the market. These devices offer a fully automated, unobtrusive and remote monitoring of main vital functions in ambulatory subjects. These unique features provide a multidimensional assessment of ambulatory CKD5D patients covering most physiologic functionalities, detecting unexpected disorders (i.e., volume overload, arrhythmias, sleep disorders) and allowing physicians to judge patient's response to treatment and recommendations. In the future, the wider availability of such pervasive health sensing and digital technology to monitor patients at an affordable cost price will improve the personalized management of CKD5D patients, so potentially resulting in improvements in patient quality of life and survival.

Nutrition Education Models for Patients With Chronic Kidney Disease

Nutrition is an integral component in the management of chronic kidney disease (CKD), and kidney health professionals play a crucial role in educating patients on dietary interventions for CKD. Several dietary modifications are indicated for CKD that require frequent adaptations with CKD progression and with underlying metabolic disturbances. However, poor adherence to dietary interventions is not uncommon among patients with CKD. An effective education program on nutrition intervention consists of providing knowledge and developing skills that are necessary to support behavioral change. The application of theoretical models of behavioral change such as social cognitive theory and the transtheoretical model in nutrition intervention has been reported to be effective in promoting changes in dietary habits. This review summarizes the evidence supporting the application of theoretical models as strategies to enhance nutrition education for patients with CKD. In addition, digital technologies are gaining interest in empowering patients and facilitating nutrition management in patients with CKD. This review also examines the applications of the latest digital technologies guided by behavioral theory in facilitating patients' changes in dietary intake patterns and lifestyle habits.

Age and sex differences in the effectiveness of intradialytic resistance training on muscle function

Previous research shows the beneficial effects of an intradialytic resistance training (IRT) on muscle function in haemodialysis patients. However, patients vary highly in their functional responses to IRT, may be due to effects of age and sex heterogeneities in adaptation. Therefore, the aim of this study was to investigate the degree to which the effects of IRT on the muscle function of haemodialysis patients vary by age and sex. We included 57 patients who completed a 12-week IRT (EXG) and 33 patients who received no IRT (CNG) during haemodialysis. Muscle function (MF) was assessed using dynamometry before and after a 12-week intervention and after a 12-week follow-up. After the 12-week intervention, we found a moderation effect of age in the relative (%) change (p = 0.011) and absolute (Δ) change (p = 0.027) of MF, and a moderation effect of sex in %MF (p = 0.001), but not in ΔMF (p = 0.069). Regarding patients' age, the change of MF was only significantly different between EXG and CNG patients aged 60-70 years (%MF, EXG: + 34.6%, CNG: - 20.1%, p < 0.001; ΔMF, EXG: + 44.4 N, CNG: - 22.1 N, p < 0.001). Regarding patients' sex, the change of MF was only significantly different between EXG and CNG female patients (%MF, EXG: + 23.9%, CNG: - 23.6%, p < 0.001). Age and sex did not significantly moderate changes in MF measures after 12 weeks of follow-up. We conclude that both age and sex of haemodialysis patients affect their functional response to IRT in the short term.Trial Registration: Intradialytic Resistance Training in Haemodialysis Patients (IRTHEP)-#NCT03511924, 30/04/2018, https://clinicaltrials.gov/ct2/show/NCT03511924 .

The "adult inactivity triad" in patients with chronic kidney disease: A review

Background

The "pediatric inactivity triad" framework consists of three complex, interrelated conditions influencing physical inactivity and associated health risks. Evidence on the beneficial effects of physical activity in adults with chronic kidney disease (CKD) continues to grow, but few studies have explored the complex interactions behind inactivity in this population.

Results

Based on the "pediatric inactivity triad" framework and prior research, we would like to propose a new concept, the "adult inactivity triad" in CKD, including (1) exercise deficit disorder, (2) sarcopenia, and (3) physical illiteracy. Individuals can shift from "adult inactivity triad" to "adult activity triad" and move at different rates and directions along the arrows in each of the three components.

Conclusion

This review explores and summarizes previous research on the three main adult inactivity triad components in the chronic kidney disease population.

Healthy aging and chronic kidney disease

The world population is aging and the prevalence of noncommunicable diseases such as diabetes, hypertension, and chronic kidney disease (CKD) will increase significantly. With advances in medical treatment and public health, the human lifespan continues to outpace the health span in such a way that the last decade of life is generally spent in poor health. In 2015, the World Health Organization defined healthy aging as 'the process of developing and maintaining the functional ability that enables wellbeing in older age.' CKD is increasingly being recognized as a model of accelerated aging and is associated with physical performance decline, cognitive decline, falls and fractures, poor quality of life, loss of appetite, and inflammation. Frailty and dementia are the final pathways and key determinants of disability and mortality independent of underlying disease. CKD, dementia, and frailty share a triangular relationship with synergistic actions and have common risk factors wherein CKD accelerates frailty and dementia through mechanisms such as uremic toxicity, metabolic acidosis and derangements, anorexia and malnutrition, dialysis-related hemodynamic instability, and sleep disturbance. Frailty accelerates glomerular filtration decline as well as dialysis induction in CKD and more than doubles the mortality risk. Anorexia is one of the major causes of protein-energy malnutrition, which is also prevalent in the aging population and warrants screening. Healthcare systems across the world need to have a system in place for the prevention of CKD amongst high-risk older adults, focusing on screening for poor prognostic factors amongst patients with CKD such as frailty, poor appetite, and cognitive impairment and providing necessary person-centered interventions to reverse underlying factors that may contribute to poor outcomes.

Patient-reported outcomes evaluation and assessment of facilitators and barriers to physical activity in the Transplantoux aerobic exercise intervention

Background

Transplantoux’s MVT exercise intervention prepares organ transplant recipients to cycle or hike up France’s Mont Ventoux. We aimed to assess (i) MVT’s effects on patient-reported outcomes (PROs) and (ii) perceived barriers and facilitators to physical activity.

Methods

Using a hybrid design, a convenience sample of transplant recipients participating in MVT (n = 47 cycling (TxCYC); n = 18 hiking (TxHIK)), matched control transplant recipients (TxCON, n = 213), and healthy MVT participants (HCON, n = 91) completed surveys to assess physical activity (IPAQ), health-related quality of life (HRQOL; SF-36 and EuroQol VAS), mental health (GHQ-12), and depressive symptomatology, anxiety, and stress (DASS-21) at baseline, then after 3, 6 (Mont Ventoux climb), 9, and 12 months. TxCYC and TxHIK participated in a 6-month intervention of individualized home-based cycling/hiking exercise and a series of supervised group training sessions. Barriers and facilitators to physical activity (Barriers and Motivators Questionnaire) were measured at 12 months.

Results

Regarding PROs, except for reducing TxHIK stress levels, MVT induced no substantial intervention effects. For both TxCYC and TxHIK, between-group comparisons at baseline showed that physical activity, HRQOL, mental health, depressive symptomatology and stress were similar to those of HCON. In contrast, compared to TxCYC, TxHIK, and HCON, physical activity, HRQOL and mental health were lower in TxCON. TxCON also reported greater barriers, lower facilitators, and different priority rankings concerning physical activity barriers and facilitators.

Conclusion

Barely any of the PROs assessed in the present study responded to Transplantoux’s MVT exercise intervention. TxCON reported distinct and unfavorable profiles regarding PROs and barriers and facilitators to physical activity. These findings can assist tailored physical activity intervention development.

Trial registration

Clinical trial notation: The study was approved by the University Hospitals Leuven’s Institutional Review Board (B322201523602).

Experiences of adults living with a kidney transplant-Effects on physical activity, physical function, and quality of life: A descriptive phenomenological study

BACKGROUND

Although kidney transplantation is the best treatment for kidney failure, scarce research has examined its effects on physical activity, physical function and quality of life.

OBJECTIVES

To investigate the experiences of a group of adults living with advanced kidney disease focusing on quality of life, physical activity and function and to see how findings differ in a group of kidney transplant recipients.

APPROACH

Individual semi-structured interviews were conducted with adults with advanced kidney disease (n = 10; 70.5 ± 8.9 years) and adults who had received a kidney transplant (n = 10; 50.7 ± 11.5 years; transplant age: 42.7 ± 20.9 months). Interviews were transcribed verbatim, thematically analysed and composite vignettes developed.

FINDINGS

Individuals with advanced kidney disease described a sense of loss and alteration to their life plans. Kidney transplant recipients reported increased freedom, independence and a return to near normality, with improved quality of life, physical activity and function compared with their pre-transplant lives. However, transplant recipients also described living with anxiety about the health of their transplant and fear it may fail.

CONCLUSION

Whilst adults living with advanced kidney disease often experience a reduced quality of life, physical activity and function, kidney transplantation can help facilitate a return to pre-disease levels of physical activity, physical function and quality of life. However, transplant recipients also reported living with anxiety around their new kidney failing. This study demonstrates the variability in the lived experiences of adults living with advanced kidney disease or a kidney transplant and highlights the need for patient-centred care.

A 12-week personalised physical activity and dietary protein intervention for older adults undergoing peritoneal dialysis: A feasibility study

This single-arm observational study explored the feasibility and efficacy of a 12-week personalised physical activity and dietary protein intervention programme for older adults undergoing peritoneal dialysis. Older adults undergoing peritoneal dialysis received eight individualised nutrition and physical activity advice sessions provided by trained nurses. Protein intake and physical activity were regarded as primary outcomes. All data were collected at baseline and at week 12. The enrolment rate was 78.4%. Twenty-nine patients participated in the study. Of these, 86.2% (25/29) completed the intervention. There was a significant increase in protein intake (t = -4.453, P< 0.001) and physical activity levels (Z = -2.929, P = 0.004). Of the participants, 56.0% achieved the targeted protein goal, and 41.4% met the physical activity goal. The timed up-and-go performance (t = 4.135, P = 0.001) increased after intervention. Trained nurses can successfully implement personalised diet and physical activity advice, and achieve promising patient outcomes.

Physical activity and the 'pediatric inactivity triad' in children living with chronic kidney disease: a narrative review

The ‘paediatric inactivity triad’ (PIT) framework consists of three complex inter-related conditions that influence physical inactivity and related health risks. In those living with chronic kidney disease (CKD), a multi-factorial milieu of components likely confound the PIT elements, resulting in a cycle of decreased physical functioning and reduced physical activity. In this review, we explore and summarize previous research on each of the three principal PIT components (exercise deficit disorder, dynapenia, and physical illiteracy) in the pediatric CKD population. We found those living with CKD are significantly physically inactive compared to their peers. Physical inactivity occurs early in the disease process and progressively gets worse as disease burden increases. Although physical activity appears to increase post-transplantation, it remains lower compared to healthy controls. There is limited evidence on interventions to increase physical activity behaviour in this population, and those that have attempted have had negligible effects. Studies reported profound reductions in muscle strength, physical performance, and cardiorespiratory fitness. A small number of exercise-based interventions have shown favourable improvements in physical function and cardiorespiratory fitness, although small sample sizes and methodological issues preclude the generalization of findings. Physical activity must be adapted and individualized to the needs and goals of the children, particularly those with acute and chronic medical needs as is the case in CKD, and further work is needed to define optimal interventions across the life course in this population if we aim to prevent physical activity declining further.

Initiation of Dialysis Is Associated With Impaired Cardiovascular Functional Capacity

Background The transition to dialysis period carries a substantial increased cardiovascular risk in patients with chronic kidney disease. Despite this, alterations in cardiovascular functional capacity during this transition are largely unknown. The present study therefore sought to assess ventilatory exercise response measures in patients within 1 year of initiating dialysis. Methods and Results We conducted a cross-sectional study of 241 patients with chronic kidney disease stage 5 from the CAPER (Cardiopulmonary Exercise Testing in Renal Failure) study and from the intradialytic low-frequency electrical muscle stimulation pilot randomized controlled trial cohorts. Patients underwent cardiopulmonary exercise testing and echocardiography. Of the 241 patients (age, 48.9 [15.0] years; 154 [63.9%] men), 42 were predialytic (mean estimated glomerular filtration rate, 14 mL·min-1·1.73 m-2), 54 had a dialysis vintage ≤12 months, and 145 had a dialysis vintage >12 months. Dialysis vintage ≤12 months exhibited a significantly impaired cardiovascular functional capacity, as assessed by oxygen uptake at peak exercise (18.7 [5.8] mL·min-1·kg-1) compared with predialysis (22.7 [5.2] mL·min-1·kg-1; P<0.001). Dialysis vintage ≤12 months also exhibited reduced peak workload, impaired peak heart rate, reduced circulatory power, and increased left ventricular mass index (P<0.05 for all) compared with predialysis. After excluding those with prior kidney transplant, dialysis vintage >12 months exhibited a lower oxygen uptake at peak exercise (17.0 [4.9] mL·min-1·kg-1) compared with dialysis vintage ≤12 months (18.9 [5.9] mL·min-1·kg-1; P=0.033). Conclusions Initiating dialysis is associated with a significant impairment in oxygen uptake at peak exercise and overall decrements in ventilatory and hemodynamic exercise responses that predispose patients to functional dependence. The magnitude of these changes is comparable to the differences between low-risk New York Heart Association class I and higher-risk New York Heart Association class II to IV heart failure.