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      The association of physical function and physical activity with all-cause mortality and adverse clinical outcomes in nondialysis chronic kidney disease: a systematic review

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          Abstract

          <div class="section"> <a class="named-anchor" id="section1-2040622318785575"> <!-- named anchor --> </a> <h5 class="section-title" id="d5134295e187">Objective:</h5> <p id="d5134295e189">People with nondialysis-dependent chronic kidney disease (CKD) and renal transplant recipients (RTRs) have compromised physical function and reduced physical activity (PA) levels. Whilst established in healthy older adults and other chronic diseases, this association remains underexplored in CKD. We aimed to review the existing research investigating poor physical function and PA with clinical outcome in nondialysis CKD. </p> </div><div class="section"> <a class="named-anchor" id="section2-2040622318785575"> <!-- named anchor --> </a> <h5 class="section-title" id="d5134295e192">Data sources:</h5> <p id="d5134295e194">Electronic databases (PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials) were searched until December 2017 for cohort studies reporting objective or subjective measures of PA and physical function and the associations with adverse clinical outcomes and all-cause mortality in patients with nondialysis CKD stages 1–5 and RTRs. The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42016039060). </p> </div><div class="section"> <a class="named-anchor" id="section3-2040622318785575"> <!-- named anchor --> </a> <h5 class="section-title" id="d5134295e197">Review methods:</h5> <p id="d5134295e199">Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare and Research Quality (AHRQ) standards. </p> </div><div class="section"> <a class="named-anchor" id="section4-2040622318785575"> <!-- named anchor --> </a> <h5 class="section-title" id="d5134295e202">Results:</h5> <p id="d5134295e204">A total of 29 studies were included; 12 reporting on physical function and 17 on PA. Only eight studies were conducted with RTRs. The majority were classified as ‘good’ according to the AHRQ standards. Although not appropriate for meta-analysis due to variance in the outcome measures reported, a coherent pattern was seen with higher mortality rates or prevalence of adverse clinical events associated with lower PA and physical function levels, irrespective of the measurement tool used. Sources of bias included incomplete description of participant flow through the study and over reliance on self-report measures. </p> </div><div class="section"> <a class="named-anchor" id="section5-2040622318785575"> <!-- named anchor --> </a> <h5 class="section-title" id="d5134295e207">Conclusions:</h5> <p id="d5134295e209">In nondialysis CKD, survival rates correlate with greater PA and physical function levels. Further trials are required to investigate causality and the effectiveness of physical function and PA interventions in improving outcomes. Future work should identify standard assessment protocols for PA and physical function. </p> </div>

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          Cardiovascular mortality risk in chronic kidney disease: comparison of traditional and novel risk factors.

          David Siscovick, Teri A. Manolio, Mary Cushman … (2005)
          Elderly persons with chronic kidney disease have substantial risk for cardiovascular mortality, but the relative importance of traditional and novel risk factors is unknown. To compare traditional and novel risk factors as predictors of cardiovascular mortality. A total of 5808 community-dwelling persons aged 65 years or older living in 4 communities in the United States participated in the Cardiovascular Health Study cohort. Participants were initially recruited from 1989 to June 1990; an additional 687 black participants were recruited in 1992-1993. The average length of follow-up in this longitudinal study was 8.6 years. Cardiovascular mortality among those with and without chronic kidney disease. Chronic kidney disease was defined as an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m2. Among the participants, 1249 (22%) had chronic kidney disease at baseline. The cardiovascular mortality risk rate was 32 deaths/1000 person-years among those with chronic kidney disease vs 16/1000 person-years among those without it. In multivariate analyses, diabetes, systolic hypertension, smoking, low physical activity, nonuse of alcohol, and left ventricular hypertrophy were predictors of cardiovascular mortality in persons with chronic kidney disease (all P values <.05). Among the novel risk factors, only log C-reactive protein (P = .05) and log interleukin 6 (P<.001) were associated with the outcome as linear predictors. Traditional risk factors were associated with the largest absolute increases in risks for cardiovascular deaths among persons with chronic kidney disease: for left ventricular hypertrophy, there were 25 deaths per 1000 person-years; current smoking, 20 per 1000 person-years; physical inactivity, 15 per 1000 person-years; systolic hypertension, 14 per 1000 person-years; diabetes, 14 per 1000 person-years; and nonuse of alcohol, 11 per 1000 person-years vs 5 deaths per 1000 person-years for those with increased C-reactive protein and 5 per 1000 person-years for those with increased interleukin 6 levels. A receiver operating characteristic analysis found that traditional risk factors had an area under the curve of 0.73 (95% confidence interval, 0.70-0.77) among those with chronic kidney disease. Adding novel risk factors only increased the area under the curve to 0.74 (95% confidence interval, 0.71-0.78; P for difference = .15). Traditional cardiovascular risk factors had larger associations with cardiovascular mortality than novel risk factors in elderly persons with chronic kidney disease. Future research should investigate whether aggressive lifestyle intervention in patients with chronic kidney disease can reduce their substantial cardiovascular risk.
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            Physical activity and mortality in chronic kidney disease (NHANES III).

            David B Baird, Tom Greene, Jill Neilson … (2009)
            Chronic kidney disease (CKD) is associated with impaired physical activity. However, it is unclear whether the associations of physical activity with mortality are modified by the presence of CKD. Therefore, we examined the effects of CKD on the associations of physical activity with mortality. This was an observational study of 15,368 adult participants in the National Health and Nutrition Examination Survey III; 5.9% had CKD (eGFR 0.3). Physical inactivity is associated with increased mortality in CKD and non-CKD populations. As in the non-CKD population, increased physical activity might have a survival benefit in the CKD population.
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              Hemodialysis patient-assessed functional health status predicts continued survival, hospitalization, and dialysis-attendance compliance.

              P B DeOreo (1997)
              We asked patients to assess their functional health status by completing the SF-36. Over 2 years, we studied 1,000 patients (average age, 58 years; 50% male; 25% white; 36% diabetic) in three outpatient, staff-assisted hemodialysis units. We used both the eight-scale scores and two-component summary scores to study the relationship between baseline functional health status and clinical outcomes. The physical component summary (PCS) score was as significant a predictor of mortality as was the normalized protein catabolic rate or the delivered Kt/V. Patients with a PCS score below the median for our patients (< 34) were twice as likely to die and 1.5 times more likely to be hospitalized as patients with PCS scores at or above the median score. Either a low PCS score or a low mental component summary (MCS) score correlated with the number of days of hospitalization. While the average dialysis patient has a relatively normal (47 v 50) MCS score and a low (37 v 50) PCS score compared with the normal population, patients who skipped more than two treatments per month tended to have a relatively higher PCS score (judged themselves physically healthier) and a relatively lower MCS score (judged themselves less mentally healthy) than patients who did not skip two or more treatments per month. The prevalence of depression as defined by an MCS score of < or = 42 was approximately 25%. The SF-36 provided a good screening tool for patients at high risk for death, hospitalization, poor attendance, and depression.
              Article 0 comments Cited 89 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: Therapeutic Advances in Chronic Disease
                Abbreviated Title: Therapeutic Advances in Chronic Disease
                Publisher: SAGE Publications
                ISSN (Print): 2040-6223
                ISSN (Electronic): 2040-6231
                Publication date Created: July 04 2018
                Publication date Created: November 2018
                Publication date (Electronic): July 04 2018
                Publication date (Print): November 2018
                Volume: 9
                Issue: 11
                Pages: 209-226
                Affiliations
                [1 ]Leicester Kidney Lifestyle Team, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
                [2 ]John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
                [3 ]Leicester Kidney Lifestyle Team, Department of Infection, Immunity and Inflammation, University of Leicester, LE1 7RH Leicester, UK
                [4 ]School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
                [5 ]Centre for Exercise and Rehabilitation Services, University Hospitals of Leicester NHS Trust, Leicester, UK
                Article
                DOI: 10.1177/2040622318785575
                PMC ID: 6196637
                PubMed ID: 30364521
                SO-VID: 06eb2ee7-d627-4874-9877-4faf3a7d1051
                Copyright © © 2018
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