Lower C‐reactive protein and better hemodialysis survival are associated with regular exercise activity: Longitudinal outcomes from the ACTIVE‐ADIPOSE special study

Abstract

Introduction Cross-sectional and longitudinal studies in the general population have shown that a physically active lifestyle may have anti-inflammatory properties, but evidence from studies conducted with maintenance hemodialysis (HD) patients is limited. Methods A multicenter prospective cohort of 755 HD participants aged 20-92 was evaluated in a USRDS special study 2009-2013. Kilocalories/week (kcal/week) of leisure time physical activity (LTPA) was estimated from the Minnesota Leisure Time Activity questionnaire. Predialysis serum samples were obtained concurrent with LTPA report date. Generalized estimating equations (GEE) examined association of participants' LTPA and log-normalized CRP across 24 months. Cox proportional hazards models investigated LTPA and survival over a median follow-up of 718 days. Findings Baseline median CRP concentration was lower for participants with 500+ kcal/week LTPA vs. those with <500 kcal/week LTPA (3.4 mg/L vs. 4.6 mg/L; P = 0.03). Participants who reported lower LTPA (<500 kcal/week) at both baseline and 12 months had a borderline significant increase in CRP concentration (within-group change 4.8 [1.9-10.4] to 5.8 [1.6-15.7]; P = 0.08). Lower LTPA was associated with higher log CRP over 24 months in adjusted GEE analyses (β coefficient = 0.16 [95% CI 0.02-0.31]; P = 0.03). 67/364 (18%) and 43/391 (11%) deaths occurred, respectively, among participants reporting <500 vs. 500+ kcal/week LTPA [adjusted mortality hazard ratio 1.63 (CI, 1.07, 2.47)]. Discussion The data suggest that increased estimated levels of LTPA, a physical activity/exercise opportunity widely applicable to HD patients, may be associated with lower CRP concentration as well as better survival outcome.

Frailty as a dynamic process in a diverse cohort of older persons with dialysis-dependent CKD

“…Cross-sectional and longitudinal studies in the general population have shown that a physically active lifestyle may have anti-inflammatory properties, but evidence from studies conducted with maintenance HD patients is limited. In a previously reported multivariable analysis using data for the full AAS cohort age ≥18, adjusted for participant age, we found that non-sedentary behavior was associated with lower log-normalized CRP over 24 months ( 13 ).…”

“…An individual who expends <500 kcal/week in LTPA over a 7-day period can be considered sedentary, and the cut point of 500 kcal/week therefore provides a metric for identifying participants with less active vs. more active behavior and lifestyle ( 12 ). Participants with <500 vs. ≥500 kcal/week estimated LTPA energy expenditure were classified as demonstrating a sedentary vs. non-sedentary profile at baseline and at 12- and 24-month follow-ups ( 13 ).…”

Does Intradialytic Group Exercise Influence Malnutrition and Quality of Life in Maintenance Hemodialysis Patients? Evidence From an Experimental Study Using a Single-group Repeated-measures Design

“…Previous studies have con rmed that exercise could bring dialysis patients with better exercise capacity [3], physical function [4,17,31], sleep quality [4], nutritional status [31], psychological status [10], quality of life [10,31], and better hemodialysis survival [11]. Exercise ways in MHD patients can be divided into three major types, including aerobic exercise, resistance exercise and a combination of aerobic exercise and resistance exercise.…”

“…Exercise training, as a type of physical activity, has been shown great bene ts for MHD patients. Suitable and regular exercise can improve their physical function, nutritional status, psychological status, survival rate and QOL [10][11][12][13].…”