Associations of exercise habits with physical function and emergency dialysis start in patients with end-stage renal disease before dialysis initiation.

BACKGROUND

In chronic kidney disease (CKD), declining physical function predicts adverse outcomes at dialysis initiation, highlighting the importance of promoting regular exercise habits. However, exercise is frequently discouraged immediately before dialysis initiation because of concerns regarding volume overload and hemodynamic instability. Evidence regarding the effectiveness and safety of habitual exercise during this period remains limited. This study examined associations between exercise habits, physical function, and emergency dialysis initiation among patients with end-stage renal disease (ESRD).

METHODS

This cross-sectional study included patients with ESRD who initiated hemodialysis at the Hamamatsu University Hospital between August 2022 and April 2025. Exercise habits were assessed using the stages-of-change model, with action or maintenance stages indicating habitual exercise. The outcomes were Short Physical Performance Battery (SPPB) scores at dialysis initiation and emergency dialysis initiation. Associations with SPPB were analyzed using ordinal logistic regression, and associations with emergency initiation were analyzed using modified Poisson regression with robust variance.

RESULTS

Among 124 patients, 27 (21.8%) had exercise habits. Exercise habits were associated with higher SPPB categories (odds ratio [OR], 5.88; 95% confidence interval [CI] 1.66-20.81; p = 0.008). Emergency dialysis initiation occurred in 27.4% of patients (14.8% vs 30.9%) and was not significantly associated with exercise habits (risk ratios, 0.37; 95% CI 0.12-1.09; p = 0.071).

CONCLUSIONS

Among patients with ESRD, immediately before dialysis initiation, exercise habits were associated with better physical function but were not significantly associated with emergency dialysis initiation.