A BERNIER-JEAN1, G WONG1, V SAGLIMBENE1,2, M RUOSPO2, S PALMER3, P NATALE2,4, V GARCIA-LARSEN5, D W JOHNSON6,7, M TONELLI8, J HEGBRAN9, J C CRAIG10, A TEIXEIRA-PINTO1, G FM STRIPPOLI1,4
1School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia, 2Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden, 3Department of Medicine, University of Otago, Christchurch, New Zealand, 4Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy, 5Program in Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, USA, 6Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia, 7Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia, 8University of Calgary, Calgary, Canada, 9Department of Nephrology, Lund University, Lund, Sweden, 10College of Medicine and Public Health, Flinders University, Adelaide, Australia
Aim: To assess the association between self-reported physical activity (PA) and mortality in a large cohort of people receiving maintenance hemodialysis (MHD).
Background: People receiving MHD treatments are at significantly higher risk of cardiovascular disease and death. Regular exercise training reduces cardiovascular mortality in people with coronary heart disease, but the potential survival benefits for adults undergoing MHD are unproven.
Methods: DIET-HD is a prospective, multinational study of adults undergoing MHD in Europe and South America. We classified participants as sedentary, exercises up to once a week (‘occasional PA’), or exercises twice a week or more (‘frequent PA’), using a self-reported question. We balanced the baseline characteristics, including socio-demographic factors, comorbidities, blood chemistry and dietary intake, across the exposure groups using propensity scores. We conducted weighted Cox proportional hazards models with double robust estimators to assess the association between PA and mortality.
Results: Of the 8043 participants initially included in the DIET-HD study, 6147 (76%) had information on PA. 1226 (20%) exercised frequently, 1981 (32%) exercised occasionally and 2940 (48%) were sedentary. During a median follow-up of 3.82 years (19 677 person-years), 2337 (38%) deaths occurred, of which 1050 (45%) were from cardiovascular (CV) causes. After propensity score-weighing and adjustment for potential confounders, compared to sedentary individuals, occasional and frequent exercisers were at lower risk of all-cause mortality (hazard ratio (HR)=0.80, 95% CI 0.72 to 0.89, and 0.82, 95% CI 0.71 to 0.95, respectively). We observed a dose-dependent effect for CV death (HR=0.82, 95% CI 0.70 to 0.96, and 0.77, 95% CI 0.62 to 0.94, respectively; p trend=0.01).
Conclusions: Regular PA is associated with a lower risk of CV mortality in adults receiving MHD.
Amelie Bernier-Jean is a Canadian nephrologist with a Master of Clinical Epidemiology from the University of Sydney. She is soon to complete a PhD on the epidemiology of lifestyle factors in chronic kidney disease at the Sydney School of Public Health, for which she was awarded an NHMRC Post-Graduate Scholarship.