Department of Medicine, Faculty of Medicine, University of Calgary, Alberta, Canada.
Clin J Am Soc Nephrol. 2012 Apr;7(4):573-80. doi: 10.2215/CJN.07990811. Epub 2012 Feb 16.
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).
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).
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.
与普通人群相比，慢性肾脏病（CKD）患者的运动能力在年轻时就受到损害。本研究旨在评估杜克活动状态指数（DASI）问卷作为测量 3-4 期 CKD（估算肾小球滤过率[eGFR]，15-59ml/min/1.73m2）患者运动能力的可靠性。
设计、地点、参与者和测量方法：在一个推导样本（n=23）中，在基线和 6 个月时从 DASI 反应和心肺运动试验测量中获得峰值摄氧量（VO2peak），在一个验证样本（n=20）中仅进行一次测量。使用 Bland-Altman 分析和线性混合模型来估计偏差、一致性相关系数和组内相关系数，作为个体间差异（组内信度）和方法间差异（重测信度）的比例。
两个样本在年龄（平均 60±14 岁）、eGFR（35.5±15ml/min/1.73m2）、男性（53%）和糖尿病（56%）方面具有同质性。平均测量的 VO2peak 为 16.5±4ml/kg/min。DASI 问卷高估了 VO2peak，平均高估了 4.3ml/kg/min。当 eGFR 为≥35ml/min/1.73m2（中位数）时，组内信度为 53%；当 eGFR <35ml/min/1.73m2 时，组内信度为 60%（P<0.01）。当 eGFR <35ml/min/1.73m2 时，重测信度为 81%；当 eGFR ≥35ml/min/1.73m2 时，重测信度为 71%（P<0.01）。
DASI 问卷可能是 CKD 患者运动能力的可靠测量方法，尤其是当 eGFR <35ml/min/1.73m2 时。需要进行更大的前瞻性研究来确定其预后价值。
