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Abstract: PO1038

Physical Activity and Mortality in Adults Undergoing Hemodialysis: A DIET-HD Cohort Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Bernier-Jean, Amelie, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  • Wong, Germaine, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  • Saglimbene, Valeria Maria, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
  • Ruospo, Marinella, Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
  • Palmer, Suetonia, Department of Medicine, University of Otago, Christchurch, New Zealand
  • Natale, Patrizia, Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
  • Garcia-Larsen, Vanessa, Program in Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Johnson, David W., Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  • Tonelli, Marcello, University of Calgary, Calgary, Alberta, Canada
  • Craig, Jonathan C., College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
  • Strippoli, Giovanni F.M., School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
Background

People receiving maintenance hemodialysis (MHD) are at higher risk of cardiovascular disease (CVD) and death. Regular exercise training reduces CVD mortality in people with coronary heart disease, but the potential survival benefits for adults undergoing MHD are unproven. We assessed the association between self-reported physical activity (PA) and mortality in a very large cohort of people receiving MHD.

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 PA 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%) 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 CVD causes. After propensity score-weighing and adjustment for potential confounders, PA was associated with a lower risk of all-cause mortality, CVD mortality and non-CVD mortality (Table). We observed a dose-dependent effect of PA for CVD death.

Conclusion

Regular PA is associated with a lower risk of CVD mortality in adults receiving MHD. Until randomised control trials assess whether PA improves survival in MHD, it should be considered as part of the clinical management of MHD patients.

PA levelAdjusted Hazard RatioPooled PP trend
Sedentary10.00010.002
Occasional0.80 (0.72 to 0.89)
Frequent0.82 (0.71 to 0.95)
CV mortality:   
Sedentary10.0090.007
Occasional0.82 (0.70 to 0.96)
Frequent0.77 (0.62 to 0.94)
Non-CV mortality:   
Sedentary10.020.13
Occasional0.81 (0.69 to 0.94)
Frequent0.88 (0.72 to 1.08)

Funding

  • Government Support - Non-U.S.