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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
The Duke Activity Status Index in patients with chronic kidney disease: a reliability study
Pietro Ravani1, Brett Kilb, Harman Bedi
1Department of Medicine, Faculty of Medicine, University of Calgary, Alberta, Canada. pravani@ucalgary.ca
Insights
The Duke Activity Status Index (DASI) questionnaire shows good reliability for measuring exercise capacity in chronic kidney disease (CKD) patients, particularly those with lower estimated glomerular filtration rates (eGFR). This tool can help assess fitness in CKD populations.
Area of Science:
- Nephrology
- Cardiopulmonary Exercise Testing
- Clinical Assessment Tools
Background:
- Exercise capacity is significantly reduced in chronic kidney disease (CKD) patients, often manifesting at an earlier age compared to the general population.
- Accurate assessment of exercise capacity is crucial for managing CKD patients, yet reliable and accessible tools are needed.
- The Duke Activity Status Index (DASI) questionnaire is a potential tool for estimating exercise capacity.
Purpose of the Study:
- To evaluate the reliability of the Duke Activity Status Index (DASI) questionnaire for measuring exercise capacity in medically stable adults with stage 3-4 CKD.
- To compare DASI-estimated peak oxygen uptake (VO2peak) with measurements from cardiopulmonary exercise testing (CPET).
- To assess the test-retest and inter-rater reliability of the DASI in this patient population.
Main Methods:
- A derivation sample (n=23) and a validation sample (n=20) of stage 3-4 CKD patients were included.
- Peak oxygen uptake (VO2peak) was estimated using DASI responses and measured via CPET.
- Bland-Altman analysis and linear mixed models were employed to assess bias, concordance, and intraclass correlation coefficients for reliability.
Main Results:
- The DASI questionnaire tended to overestimate measured VO2peak by 4.3 ml/kg per min.
- Intertest reliability varied, with higher reliability (60%) observed when estimated glomerular filtration rate (eGFR) was <35 ml/min per 1.73 m(2) compared to ≥35 ml/min per 1.73 m(2) (53%).
- Test-retest reliability was notably higher when eGFR was <35 ml/min per 1.73 m(2) (81%) versus ≥35 ml/min per 1.73 m(2) (71%).
Conclusions:
- The DASI questionnaire demonstrates potential as a reliable tool for assessing exercise capacity in CKD patients.
- Reliability appears particularly strong in patients with more advanced CKD (eGFR <35 ml/min per 1.73 m(2)).
- Further prospective research is warranted to confirm the prognostic value of DASI in CKD populations.
Background And Objectives:
Exercise capacity is impaired at a younger age in CKD patients than in the general population. This study examined the reliability of the Duke Activity Status Index (DASI) questionnaire as a measure of exercise capacity in medically stable adults with stage 3-4 CKD (estimated GFR [eGFR], 15-59 ml/min per 1.73 m(2)).
Design, Setting, Participants, & Measurements:
Peak oxygen uptake (VO(2)peak), estimated from DASI responses and cardiopulmonary exercise test measurements, was obtained at baseline and 6 months in a derivation sample (n=23) and once in a validation sample (n=20). Bland-Altman analysis and linear mixed models were used to estimate bias, concordance correlation coefficients, and intraclass correlation coefficients as the proportion of the variance due to participant (intertest reliability) and method (test-retest reliability).
Results:
The two samples were homogeneous with respect to age (mean 60 ± 14 years), eGFR (35.5 ± 15 ml/min per 1.73 m(2)), male sex (53%), and diabetes (56%). Mean measured VO(2)peak was 16.5 ± 4 ml/kg per min. The DASI questionnaire overestimated VO(2)peak by 4.3 ml/kg per min. Intertest reliability was 53% when eGFR was ≥35 ml/min per 1.73 m(2) (median) and 60% when eGFR was <35 ml/min per 1.73 m(2) (P<0.01). Test-retest reliability was 81% when eGFR was <35 ml/min per 1.73 m(2) and 71% when eGFR was ≥35 ml/min per 1.73 m(2) (P<0.01).
Conclusions:
The DASI questionnaire may be a reliable measure of exercise capacity in CKD patients, especially when eGFR is <35 ml/min per 1.73 m(2). Larger prospective studies are needed to determine its prognostic value.
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