American journal of kidney diseases : the official journal of the National Kidney Foundation · 2025
Accelerometry-Derived Physical Activity Levels and Mortality in Hemodialysis Patients: A Prospective Cohort Study.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Hiraoka Atsuko, Sakaguchi Yusuke, Kadono Hikaru, Kawaoka Takayuki, Oka Tatsufumi, Doi Yohei, Kawano Yuki, Kishimoto Hiro, Saito Takafumi, Yamamoto Ryohei, Matsui Isao, Mizui Masayuki, Kaimori Jun-Ya, Isaka Yoshitaka
Аннотация
RATIONALE & OBJECTIVE: Sedentary behavior is common among hemodialysis patients although large-scale data on physical activity (PA) objectively measured by accelerometers are scarce. We (1) compared PA levels between hemodialysis patients and community-dwelling adults, 2) estimated annual PA changes, and 3) determined associations between PA levels and mortality in hemodialysis patients.
STUDY DESIGN: Prospective cohort study.
SETTING & PARTICIPANTS: 1,030 Japanese hemodialysis patients enrolled for PA measurements between June 2019 and July 2020 and followed for 3 years. PA data in community-dwelling adults were obtained from the Dazaifu-City Survey in Japan.
EXPOSURE: Light-intensity PA, moderate-intensity PA, vigorous-intensity PA, and steps measured by triaxial accelerometers after enrollment and 1 year later, defined based on 10-second epoch-averaged metabolic equivalents (METs) of 1.6-2.9, 3.0-5.9, and ≥6.0, respectively.
OUTCOME: All-cause death.
ANALYTICAL APPROACH: Cox proportional hazards models with least absolute shrinkage and selection operator (LASSO).
RESULTS: The median light-intensity PA, moderate-intensity PA, vigorous-intensity PA, and steps were 192 (IQR, 128-263) minutes/day, 70 (IQR, 26-169) minutes/week, 0 (IQR, 0-0) minutes/week, and 1,832 (IQR, 680-3,822)/day, respectively. Age- and sex-adjusted geometric means of light-intensity PA, moderate-to-vigorous intensity PA, and steps were 42%, 77%, and 73% lower among hemodialysis patients than community-dwelling adults. The least-squares mean annual changes in light-intensity PA, moderate-intensity PA, and steps were -12.4 minutes/day, -10.7 minutes/week, and -215 steps/day, respectively. The lowest hazard was observed at 216-262 minutes/day for light-intensity PA, 239-291 minutes/week for moderate-intensity PA, and 4,294-6,045/day for steps. LASSO identified light-intensity PA on nondialysis days as the parameter most strongly associated with survival. The lowest mortality risk was observed at about 300 minutes/day of light-intensity PA on nondialysis days compared with about 200 minutes/day on dialysis days.
LIMITATIONS: Observational study design precludes causal inference.
CONCLUSIONS: Light-intensity PA on nondialysis days, even for short durations, was associated with better survival in hemodialysis patients.
PLAIN-LANGUAGE SUMMARY: Sedentary behavior is prevalent in hemodialysis patients. Although current guidelines recommend 150-300 minutes/week of moderate-intensity physical activity (PA) (eg, brisk walking, cycling at a moderate pace, jogging) or 75-150 minutes/week of vigorous-intensity PA (eg, running, sprinting), it is uncertain whether these targets are applicable to hemodialysis patients who have a high prevalence of frailty. In this 3-year prospective cohort study involving 1,030 Japanese hemodialysis patients, light-intensity PA (eg, casual walking, light household activities, gardening, tai-chi) on nondialysis days was most closely associated with better survival among various PA parameters. The lowest mortality risk was observed at about 300 minutes/day of light-intensity PA on nondialysis days. Light-intensity PA, even for short durations, may be associated with favorable outcomes among hemodialysis patients.
STUDY DESIGN: Prospective cohort study.
SETTING & PARTICIPANTS: 1,030 Japanese hemodialysis patients enrolled for PA measurements between June 2019 and July 2020 and followed for 3 years. PA data in community-dwelling adults were obtained from the Dazaifu-City Survey in Japan.
EXPOSURE: Light-intensity PA, moderate-intensity PA, vigorous-intensity PA, and steps measured by triaxial accelerometers after enrollment and 1 year later, defined based on 10-second epoch-averaged metabolic equivalents (METs) of 1.6-2.9, 3.0-5.9, and ≥6.0, respectively.
OUTCOME: All-cause death.
ANALYTICAL APPROACH: Cox proportional hazards models with least absolute shrinkage and selection operator (LASSO).
RESULTS: The median light-intensity PA, moderate-intensity PA, vigorous-intensity PA, and steps were 192 (IQR, 128-263) minutes/day, 70 (IQR, 26-169) minutes/week, 0 (IQR, 0-0) minutes/week, and 1,832 (IQR, 680-3,822)/day, respectively. Age- and sex-adjusted geometric means of light-intensity PA, moderate-to-vigorous intensity PA, and steps were 42%, 77%, and 73% lower among hemodialysis patients than community-dwelling adults. The least-squares mean annual changes in light-intensity PA, moderate-intensity PA, and steps were -12.4 minutes/day, -10.7 minutes/week, and -215 steps/day, respectively. The lowest hazard was observed at 216-262 minutes/day for light-intensity PA, 239-291 minutes/week for moderate-intensity PA, and 4,294-6,045/day for steps. LASSO identified light-intensity PA on nondialysis days as the parameter most strongly associated with survival. The lowest mortality risk was observed at about 300 minutes/day of light-intensity PA on nondialysis days compared with about 200 minutes/day on dialysis days.
LIMITATIONS: Observational study design precludes causal inference.
CONCLUSIONS: Light-intensity PA on nondialysis days, even for short durations, was associated with better survival in hemodialysis patients.
PLAIN-LANGUAGE SUMMARY: Sedentary behavior is prevalent in hemodialysis patients. Although current guidelines recommend 150-300 minutes/week of moderate-intensity physical activity (PA) (eg, brisk walking, cycling at a moderate pace, jogging) or 75-150 minutes/week of vigorous-intensity PA (eg, running, sprinting), it is uncertain whether these targets are applicable to hemodialysis patients who have a high prevalence of frailty. In this 3-year prospective cohort study involving 1,030 Japanese hemodialysis patients, light-intensity PA (eg, casual walking, light household activities, gardening, tai-chi) on nondialysis days was most closely associated with better survival among various PA parameters. The lowest mortality risk was observed at about 300 minutes/day of light-intensity PA on nondialysis days. Light-intensity PA, even for short durations, may be associated with favorable outcomes among hemodialysis patients.