Mortality and morbidity following exercise-based renal rehabilitation in patients with chronic kidney disease: the effect of programme completion and change in exercise capacity

Greenwood, Sharlene; Castle, Ellen M.; Lindup, Herolin; Mayes, Juliet; Waite, Iain; Grant, Denise; Mangahis, Emmanuel; Crabb, Olivia; Shevket, K; Macdougall, Iain C.; MacLaughlin, Helen

doi:10.1093/ndt/gfy351

Cited by 61 publications

(44 citation statements)

References 31 publications

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“…Roshanravan and colleagues (Roshanravan et al., 2013) previously observed in a fully adjusted analysis every 0.1 m/s decrement in gait speed was associated with a 26% increase in mortality risk and for every second longer patients took to complete the “timed‐up‐and‐go” assessment there was an increased risk of 8% in CKD patients' stages 2–4. Recently Greenwood and colleagues reported an improvement of 50 m in the ISWT was associated with a 40% reduction in the risk of morbidity and mortality (Greenwood et al., 2019).…”

Section: Discussionmentioning

confidence: 99%

The association of muscle size, strength and exercise capacity with all‐cause mortality in non‐dialysis‐dependent CKD patients

Watson

Major

Wilkinson

et al. 2020

Clin Physio Funct Imaging

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Background/Objective: Patients with chronic kidney disease (CKD) are commonly reported to exhibit skeletal muscle wasting, reduced strength and exercise capacity. Evidence from patients with end-stage renal disease (ESRD) demonstrates these factors are associated with mortality, but it is unclear whether this relationship exists earlier in the illness. Our objective was to determine whether muscle size, strength or exercise capacity was associated with all-cause mortality, unscheduled hospital admissions or time to ESRD in patients not requiring dialysis. Methods: This is a prospective cohort study of 89 patients with CKD stages 3b-5 not requiring renal replacement therapy with a mean follow-up period of 3.3 years in which the contribution of predictors of rectus femoris muscle size, muscle strength, exercise capacity to all-cause mortality rates, progression to ESRD and time to first hospitalization were investigated. Results: Unadjusted analysis suggested each 1 cm 2 increase in quadriceps muscle size (measured by ultrasonography cross-sectional area) was associated with a 38% reduced risk for death (p = .006), and a 10 m improvement on the incremental shuttle walk test was associated with a 3% reduced risk for death (p = .04). However, this relationship was not present in analysis adjusted for age, gender and eGFR. No association was seen between any factor for the development of ESRD or time to first hospitalization. Conclusion: These results suggest that in this small cohort, muscle size and exercise capacity are associated with mortality when considered alone, but this relationship was not present in adjusted analyses. Further investigation in a larger patient group is warranted.

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Section: Discussionmentioning

confidence: 99%

The association of muscle size, strength and exercise capacity with all‐cause mortality in non‐dialysis‐dependent CKD patients

Watson

Major

Wilkinson

et al. 2020

Clin Physio Funct Imaging

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“…Howden et al reported that 12-month exercise and lifestyle interventions improved 6minute walk distances in patients with CKD stages ranging from 3 to 4 [53]. Greenwood et al showed that the completion of a 12-week exercise rehabilitation regimen enhanced physical performance and reduced cardiovascular morbidity [54]. However, the effects of exercise training on sarcopenia are unclear in patients with CKD.…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia is an independent predictor of hospitalization in chronic kidney disease outpatients

Jeong

Yang

Lee

et al. 2020

Preprint

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Background/AimsPatients with chronic kidney disease (CKD) experience much more marked and earlier muscle wasting than subjects who do not have chronic illnesses. However, a few studies that have examined sarcopenia have been reported in CKD patients. We investigated the prevalence of sarcopenia in predialysis and dialysis outpatients with CKD and explored its relationship with the clinical outcomes.MethodsSarcopenia was defined as reduced muscle strength accompanied by decreased adjusted appendicular skeletal muscle (ASM), while those patients who exhibited only one of these characteristics were categorized as presarcopenic patients. ASM was measured by bioimpedence analysis, and muscle strength was evaluated by handgrips. ASM was adjusted by weight (ASM/wt). Patients were prospectively followed for up to 2 years.ResultsOne hundred seventy-nine patients were recruited (114 male and 65 female patients who were classified into 103 predialysis patients and 76 dialysis patients, with 44.7% having diabetes). Their mean age was 60.6 ± 13.5 years old. The prevalence of sarcopenia was 9.5%, while 55.9% of the patients were categorized as presarcopenic. The ASM/wt index showed significant correlations with age, handgrip strength, HOMA-IR and frailty scores. Multivariate Cox proportional hazards models demonstrated that the risk of hospitalization was significantly higher for patients with presarcopenia [hazard ratio (HR), 2.48; 95% confidence interval (CI), 1.180–5.230], and the risk of hospitalization was much higher for patients with sarcopenia than for patients in the nonsarcopenic group (HR, 9.11; 95% CI, 2.295–25.182)ConclusionsSarcopenia and presarcopenia, which were defined using the ASM/wt index and handgrip strength, predicted a poorer, hospitalization-free survival in CKD patients.

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“…Some studies correlate poorer 6-MWT performance with higher risk of mortality and hospitalizations 8 . Many studies have reported the impact of physical inactivity on increased mortality in hemodialysis patients [9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

“…Physical inactivity is well established as a strong independent risk factor for cardiovascular events. In a study by Greenwood and colleagues, it was found that in chronic renal patients undergoing a cardiopulmonary rehabilitation program, those who completed training had an increase in days free of cardiovascular events, with improvement in distance covered in a physical exercise test 11 . The aim of this study was to verify even if there is an association between autonomic cardiac dysfunction and walking test performance in hemodialysis patients.…”

Section: Introductionmentioning

confidence: 99%

Positive correlation between six-minute walk test and heart rate variability in hemodialysis patients

Carneiro

Azoubel

Sá

et al. 2020

Preprint

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Background Autonomic dysfunction is a prevalent clinical condition in chronic renal patients on hemodialysis and adds patient’s worse cardiovascular outcome, some studies in several populations relate worse cardiorespiratory performance with higher dysautonomia, but among chronic renal patients on hemodialysis these studies are still limited. The aim of this study was to verify whether there is an association between autonomic cardiac dysfunction and walking test performance in hemodialysis patients. Methods A cross-sectional study was performed in 61 patients undergoing hemodialysis therapy performed clinical examination, blood sampling, electrocardiography of heart rate variability and 6-minute walk test. Results There was a positive correlation between the 6 minute walking test and the heart rate variability variables RMSSD (r = 0.37 p = 0.005) and SD1 (r = 0.37 p = 0.0059) (Figures 1) (showing parasympathetic integrity), and there was a negative correlation with the pretest walking heart rate with these same variables (r = -0.33 p = 0.014) and (r = -0.34 p = 0.015) Regarding the walking test, it was negatively correlated with age (r = -0.39 p = 0.003) and positive with time on hemodialysis (r = 0.27 p = 0.04) Conclusions Therefore, it is verified that the 6-minute walking test can be used to estimate autonomic dysfunction in hemodialysis patients and thus help in the screening of this dysfunction including the elaboration of treatment strategies.

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Mortality and morbidity following exercise-based renal rehabilitation in patients with chronic kidney disease: the effect of programme completion and change in exercise capacity

Cited by 61 publications

References 31 publications

The association of muscle size, strength and exercise capacity with all‐cause mortality in non‐dialysis‐dependent CKD patients

The association of muscle size, strength and exercise capacity with all‐cause mortality in non‐dialysis‐dependent CKD patients

Sarcopenia is an independent predictor of hospitalization in chronic kidney disease outpatients

Positive correlation between six-minute walk test and heart rate variability in hemodialysis patients

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