Nephrology News and Issues
A Canadian study suggests that increased physical activity levels may reduce all-cause mortality rates in CKD patients. Read on for more details.
More physical activity was associated with a 52% lower mortality rate for patients with chronic kidney disease (CKD), a new study published in Nephrology News and Issues revealed. Low physical activity is common in patients with CKD, and it continues to decline as the disease progresses. Few studies, however, have explored the effect of low physical activity on clinical outcomes in patients with late-stage CKD.
“Physical activity level has been shown to be a potentially modifiable risk factor for adverse outcomes in a number of populations, including individuals on [hemodialysis] HD and those with mild to moderate CKD,” Christie Rampersad, MD, of the University of Manitoba, Canada, and her research team wrote. “However, there is a paucity of studies examining this association in patients with advanced CKD who are not receiving renal replacement therapy (RRT).”
The Canadian Frailty Observation and Interventions Trial (CanFIT) is a longitudinal observational multicenter project measuring several domains of frailty in the CKD population.
The study followed 579 predominantly Caucasian patients with stages 4 to 5 CKD (eGFR <30) for 1,193 days.
Rampersad and colleagues examined the relationship between self-reported physical activity levels and:
Participants self-reported their physical activity using the physical activity scale for the elderly (PASE), which includes a variety of activities commonly performed by older adults, in areas such as:
Adjustments were made for age, sex, and comorbidities.
During the course of the study:
While there was no relation between physical activity levels and progression to kidney failure or falls, there was a 52% reduction in all-cause mortality in patients in the highest physical activity range compared with those in the lowest range. This is similar to study findings involving patients with early stage CKD and those on hemodialysis.
The lack of racial and ethnic diversity among participants limits the usefulness of the study findings. “These findings should be replicated in other settings with a higher proportion of individuals of Hispanic, African and Indigenous descent,” Rampersad and her colleagues wrote.
“Furthermore, we were unable to adjust for smoking, BMI and proteinuria, which have been shown to be independently associated with mortality in patients with advanced CKD.” Lastly, the study data were observational, not interventional, so there was no actual test that could confirm to what degree physical activity modifies risk of death or other adverse outcomes.
The findings are in line, however, with numerous other studies whose findings indicate that increasing physical activity improves the health and quality of life of CKD patients. In this respect, the study results are not surprising. Given the substantial evidence, however, “What is surprising,” wrote Ken Wilund, PhD, professor of kinesiology and community health at the University of Illinois at Urbana-Champaign, “is that little has been done to substantively address the problem of physical inactivity across the spectrum of CKD.”
According to Wilund, strategies for increasing physical activity levels for people with CKD will likely involve a variety of approaches, including:
He also recommended making renal rehabilitation a standard therapy component for patients with CKD, and officially recognizing exercise professionals as healthcare practitioners who can be reimbursed for delivering exercise programs.
*Webb, M. J. and Wilund, K. (2021, Feb. 17). More Physical Activity May Reduce Mortality in CKD by 50%. Nephrology News and Issues. https://www.healio.com/news/nephrology/20210217/more-physical-activity-may-reduce-mortality-in-ckd-by-50
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