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Association of walking with survival and RRT among patients with CKD stages 3-5
I-Ru Chen1, Su-Ming Wang1, Chih-Chia Liang1
1Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; and.
Insights
Regular walking significantly lowers mortality and the need for renal replacement therapy (RRT) in patients with chronic kidney disease (CKD). These benefits persist regardless of age, kidney function, or other health conditions.
Area of Science:
- Nephrology
- Public Health
- Exercise Science
Background:
- Physical activity is beneficial for patients with chronic kidney disease (CKD).
- Walking is a common exercise among CKD patients, but its impact on outcomes is unclear.
- This study examined the association between walking and mortality/renal replacement therapy (RRT) in CKD stages 3-5.
Purpose of the Study:
- To investigate the association of walking with overall mortality.
- To determine the association of walking with the risk of renal replacement therapy (RRT).
- To analyze these associations in patients with chronic kidney disease (CKD) stages 3-5.
Main Methods:
- A cohort of 6363 patients with CKD stages 3-5 was analyzed.
- Data were collected from June 2003 to May 2013 at China Medical University Hospital.
- Competing-risks regression models were used to assess risks of mortality and RRT.
Main Results:
- Walking patients (21.1%) had lower incidence density rates for overall mortality (2.7 vs. 5.4 per 100 person-years) and RRT (22 vs. 32.9 per 100 person-years) compared to non-walking patients.
- Walking was independently associated with reduced overall mortality (SHR=0.67) and RRT risk (SHR=0.79).
- Increased walking frequency correlated with greater risk reduction for both outcomes.
Conclusions:
- Walking is a popular and beneficial exercise for patients with chronic kidney disease (CKD).
- Engaging in walking is linked to significantly lower risks of overall mortality and renal replacement therapy (RRT).
- The positive effects of walking are independent of patient age, renal function, and comorbidities.
Background And Objectives:
Patients with CKD can benefit from an increase in physical activity. Walking is one of the most common exercises in patients with CKD; however, the association of walking with outcomes in patients with CKD is not clear. This study investigated the association of walking with overall mortality and RRT in patients with CKD stages 3-5.
Design, Setting, Participants, & Measurements:
All patients with CKD stages 3-5 in the CKD program of China Medical University Hospital from June 2003 to May 2013 were enrolled. The risks of overall mortality and RRT were analyzed using competing-risks regressions.
Results:
A total of 6363 patients (average age, 70 years) during a median of 1.3 (range=0.6-2.5) years of follow-up were analyzed. There were 1341 (21.1%) patients who reported walking as their most common form of exercise. The incidence density rate of overall mortality was 2.7 per 100 person-years for walking patients and 5.4 for nonwalking ones. The incidence density rate of RRT was 22 per 100 person-years for walking patients and 32.9 for nonwalking ones. Walking, independent of patients' age, renal function, and comorbidity, was linked to lower overall mortality and lower RRT risk in the multivariate competing-risks regression. The adjusted subdistribution hazard ratio (SHR) of walking was 0.67 (95% confidence interval [95% CI], 0.53 to 0.84; P<0.001) for overall mortality and 0.79 (95% CI, 0.73 to 0.85; P<0.001) for the risk of RRT. The SHRs of overall mortality were 0.83, 0.72, 0.42, and 0.41 for patients walking 1-2, 3-4, 5-6, and ≥7 times per week, and the SHRs of RRT were 0.81, 0.73, 0.57, and 0.56, respectively.
Conclusions:
Walking is the most popular form of exercise in patients with CKD and is associated with lower risks of overall mortality and RRT. The benefit of walking is independent of patients' age, renal function, and comorbidity.
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