TY - JOUR
T1 - Self-Reported Physical Activity and Survival in Adults Treated With Hemodialysis
T2 - A DIET-HD Cohort Study
AU - Bernier-Jean, Amelie
AU - Wong, Germaine
AU - Saglimbene, Valeria
AU - Ruospo, Marinella
AU - Palmer, Suetonia C.
AU - Natale, Patrizia
AU - Garcia-Larsen, Vanessa
AU - Johnson, David W.
AU - Tonelli, Marcello
AU - Hegbrant, Jörgen
AU - Craig, Jonathan C.
AU - Teixeira-Pinto, Armando
AU - Strippoli, Giovanni F.M.
N1 - Funding Information:
This work was supported by the provider of renal services Diaverum, which funded overhead costs for study coordinators in each contributing country and material printing. ABJ was supported by a scholarship from the National Health and Medical Research Council (GNT1151246) for the completion of this study. The contents of the published material are solely the responsibility of the individual authors and do not reflect the views of the National Health and Medical Research Council. Conception and design: ABJ, GW, VS, JCC, and GFMS. Data acquisition: MR and PN. Data analysis: ABJ, GW, VS, ATP, and GFMS. Data interpretation: ABJ, GW, VS, MR, SCP, PN, VGL, DWJ, MT, JH, JCC, ATP, and GFMS. Study supervision and mentorship: GFMS, JCC, ATP, and GW. Each author contributed important intellectual content during manuscript drafting or revision and gave final approval of the version to be submitted.
Funding Information:
This work was supported by the provider of renal services Diaverum , which funded overhead costs for study coordinators in each contributing country and material printing. ABJ was supported by a scholarship from the National Health and Medical Research Council (GNT1151246) for the completion of this study. The contents of the published material are solely the responsibility of the individual authors and do not reflect the views of the National Health and Medical Research Council.
Publisher Copyright:
© 2021 International Society of Nephrology
PY - 2021/12
Y1 - 2021/12
N2 - Introduction: Regular physical activity is associated with longevity in adults receiving hemodialysis, but it is uncertain whether this association varies by causal pathways (cardiovascular and noncardiovascular). Methods: DIET-HD was a prospective, multinational study of adults undergoing hemodialysis across Europe and Argentina. We classified participants as physically inactive, occasionally active (irregularly to once a week), or frequently active (twice a week or more), using a self-reported questionnaire. Potential confounders were balanced across exposure groups using propensity scores. Weighted Cox proportional hazards models with double robust estimators evaluated the association between physical activity and all-cause, cardiovascular, and noncardiovascular mortality. Results: Of 8043 participants in DIET-HD, 6147 (76%) had information on physical activity. A total of 2940 (48%) were physically inactive, 1981 (32%) occasionally active, and 1226 (20%) frequently active. In a median follow-up of 3.8 years (19,677 person-years), 2337 (38%) deaths occurred, including 1050 (45%) from cardiovascular causes. After propensity score weighting, occasional physical activity was associated with lower all-cause (adjusted hazard ratio [aHR] = 0.80, 95% CI = 0.72–0.89), cardiovascular (aHR = 0.82, 95% CI = 0.70–0.96), and noncardiovascular (aHR = 0.81, 95% CI = 0.69–0.94) mortality compared with inactivity. Frequent physical activity was associated with lower all-cause (aHR = 0.82, 95% CI = 0.71–0.95) and cardiovascular (aHR = 0.77, 95% CI = 0.62–0.94) mortality, but not noncardiovascular mortality (aHR = 0.88, 95% CI = 0.72–1.08). A dose-dependent association of physical activity with cardiovascular death was observed (P trend = 0.01). Conclusion: Compared with self-reported physical inactivity, occasional and frequent physical activities were associated, dose dependently, with lower cardiovascular mortality in adults receiving hemodialysis.
AB - Introduction: Regular physical activity is associated with longevity in adults receiving hemodialysis, but it is uncertain whether this association varies by causal pathways (cardiovascular and noncardiovascular). Methods: DIET-HD was a prospective, multinational study of adults undergoing hemodialysis across Europe and Argentina. We classified participants as physically inactive, occasionally active (irregularly to once a week), or frequently active (twice a week or more), using a self-reported questionnaire. Potential confounders were balanced across exposure groups using propensity scores. Weighted Cox proportional hazards models with double robust estimators evaluated the association between physical activity and all-cause, cardiovascular, and noncardiovascular mortality. Results: Of 8043 participants in DIET-HD, 6147 (76%) had information on physical activity. A total of 2940 (48%) were physically inactive, 1981 (32%) occasionally active, and 1226 (20%) frequently active. In a median follow-up of 3.8 years (19,677 person-years), 2337 (38%) deaths occurred, including 1050 (45%) from cardiovascular causes. After propensity score weighting, occasional physical activity was associated with lower all-cause (adjusted hazard ratio [aHR] = 0.80, 95% CI = 0.72–0.89), cardiovascular (aHR = 0.82, 95% CI = 0.70–0.96), and noncardiovascular (aHR = 0.81, 95% CI = 0.69–0.94) mortality compared with inactivity. Frequent physical activity was associated with lower all-cause (aHR = 0.82, 95% CI = 0.71–0.95) and cardiovascular (aHR = 0.77, 95% CI = 0.62–0.94) mortality, but not noncardiovascular mortality (aHR = 0.88, 95% CI = 0.72–1.08). A dose-dependent association of physical activity with cardiovascular death was observed (P trend = 0.01). Conclusion: Compared with self-reported physical inactivity, occasional and frequent physical activities were associated, dose dependently, with lower cardiovascular mortality in adults receiving hemodialysis.
KW - hemodialysis
KW - mortality
KW - physical activity
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U2 - 10.1016/j.ekir.2021.09.002
DO - 10.1016/j.ekir.2021.09.002
M3 - Article
C2 - 34901570
AN - SCOPUS:85117920397
SN - 2468-0249
VL - 6
SP - 3014
EP - 3025
JO - Kidney International Reports
JF - Kidney International Reports
IS - 12
ER -