Daily Step Counts in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Observational Studies

Abstract

BackgroundPhysical inactivity is an essential factor in the prognosis of patients with chronic kidney disease (CKD). Daily step count is a straightforward measure to assess physical activity levels. Understanding the step counts among different CKD stages is essential to change sedentary behavior.ObjectivesThis systematic review and meta-analysis aimed to investigate the daily step counts in patients with CKD at a different stage.DesignA systematic review and meta-analysis.Data SourcesThe literature search was performed in PubMed, Embase, and Web of Science from inception to November 3rd, 2021.Review MethodsObservational studies (cross-sectional, case-control, or cohort studies) reported specific values of step counts in CKD patients by the wearable device were included. A random-effects model was used to pool the data. Subgroup analysis explored differences in outcomes by stage of CKD. Heterogeneity between studies was assessed using the χ2 test of Cochrane's Q statistic. A contour-enhanced funnel plot was conducted to investigate publication bias. Univariate and multivariate meta-regression was conducted to examine possible sources of heterogeneity.ResultsTwenty-eight articles were identified and used for quantitative analysis. The result showed that the daily step count in patients with CKD was 4642.47 (95% CI: 4274.18–5010.76), and significantly lower than the healthy population. Subgroup analysis revealed that the step counts decreased before dialysis, dropped to a freezing point at the hemodialysis phase, and increased after kidney transplantation. Meta-regression analysis showed that daily step counts were relatively higher in the Americas or younger than 60 or kidney transplant recipients.ConclusionThe status of daily step counts in patients with CKD decreases with CKD severity and increases after kidney transplantation. Although studies have begun to focus on strategies to improve step counts in patients with CKD, future studies should focus more on step counts in pre-dialysis patients and changing their physically inactive lifestyle early to alleviate deteriorating renal function.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291551, identifier: CRD42021291551.

Continuous Long-Term Physical Activity Monitoring in Hemodialysis Patients

“…The incorporation of physical activity monitoring into clinical care has the potential to improve outcomes (12,13), but it requires consistent use of a monitoring device by patients over a long time period. However, the majority of studies quantifying activity levels in patients receiving hemodialysis have been short term, in the order of 1–2 weeks or less (6). Many used pedometers, which assess uniaxial motion of the hip (6).…”

“…Increasing adoption of wearable technologies provides a unique opportunity to understand activity patterns and their relation to clinical outcomes. Prior studies in the hemodialysis population have used wearable devices to examine physical activity levels (6), but only one has attempted long-term use (7), and few have utilized the detailed data that such devices provide (8,9). We hypothesized that highly granular data collection coupled with patient-centered outcomes measures would yield new insights into patterns of behavior and activity among patients receiving hemodialysis.…”

Home-Based Exercise in Elderly Patients with Claudication and Chronic Kidney Disease Is Associated with Lower Progressive Renal Function Worsening: A 5-Year Retrospective Study

“…This evolution, intermittent and in general unpredictable, may evolve to ESRD, driving the patients to a worsening of quality of life and posing a burden on the health service and the environment [ 34 , 35 , 36 ]. The traditional control of risk factors and the improvement of the patient’s lifestyle, tackling sedentariness for several protective benefits derived from physical activity [ 13 , 15 , 19 ], is a recommended action [ 17 , 18 , 35 ]. Moreover, in the presence of PAD where mobility is restricted and the option of revascularization may increase the risk of progressive renal dysfunction [ 6 , 7 ], rehabilitative exercise may represent the necessary tool.…”

“…As a further critical issue for PAD-CKD patients, the restricted mobility due to vascular disease and the progressive sedentariness associated with CKD severity [ 13 ] deprive patients of the protective effects related to physical activity [ 14 , 15 , 16 ].…”

Wearables in Nephrology: Fanciful Gadgetry or Prêt-à-Porter?

“…Most other evidence on wearable devices in patients with ESKD centres around the use of wearables for monitoring physical activity. In a systematic review, the mean step count was 4111 in patients on haemodialysis and 4264 in patients on peritoneal dialysis, clearly below the daily recommended target [ 42 ]. Reduced physical activity is related to mortality in this population [ 43 ], and recent studies have shown that a home-based exercise program is not only feasible [ 44 ] but also beneficial [ 45 ].…”