Claudia Torino a , Fabio Manfredini b , Davide Bolignano a , Filippo Aucella c , Rossella Baggetta a , Antonio Barillà d , Yuri Battaglia d , Silvio Bertoli e , Graziella Bonanno f , Pietro Castellino g , Daniele Ciurlino e , Adamasco Cupisti h , Graziella D'Arrigo a , Luciano De Paola i , Fabrizio Fabrizi j , Pasquale Fatuzzo f , Giorgio Fuiano l , Luigi Lombardi i , Gaetano Lucisano l , Piergiorgio Messa j , Renato Rapanà k , Francesco Rapisarda f , Stefania Rastelli g , Lisa Rocca-Rey e , Chiara Summaria l , Alessandro Zuccalà k , Giovanni Tripepi a , Luigi Catizone d , Carmine Zoccali a , Francesca Mallamaci a
29 July 2014
Background/Aims: Scarce physical activity predicts shorter survival in dialysis patients. However, the relationship between physical (motor) fitness and clinical outcomes has never been tested in these patients. Methods: We tested the predictive power of an established metric of motor fitness, the Six-Minute Walking Test (6MWT), for death, cardiovascular events and hospitalization in 296 dialysis patients who took part in the trial EXCITE (ClinicalTrials.gov Identifier: NCT01255969). Results: During follow up 69 patients died, 90 had fatal and non-fatal cardiovascular events, 159 were hospitalized and 182 patients had the composite outcome. In multivariate Cox models - including the study allocation arm and classical and non-classical risk factors - an increase of 20 walked metres during the 6MWT was associated to a 6% reduction of the risk for the composite end-point (P=0.001) and a similar relationship existed between the 6MWT, mortality (P<0.001) and hospitalizations (P=0.03). A similar trend was observed for cardiovascular events but this relationship did not reach statistical significance (P=0.09). Conclusions: Poor physical performance predicts a high risk of mortality, cardiovascular events and hospitalizations in dialysis patients. Future studies, including phase-2 EXCITE, will assess whether improving motor fitness may translate into better clinical outcomes in this high risk population.