Cobo Gabriela, Gallar Paloma, Gama-Axelsson Thiane, Di Gioia Cristina, Qureshi Abdul Rashid, Camacho Rosa, Vigil Ana, Heimbürger Olof, Ortega Olimpia, Rodriguez Isabel, Herrero Juan Carlos, Bárány Peter, Lindholm Bengt, Stenvinkel Peter, Carrero Juan Jesús
Department of Nephrology, Severo Ochoa Hospital, Leganes, Madrid, Spain.
J Nephrol. 2015 Aug;28(4):503-10. doi: 10.1007/s40620-014-0164-y. Epub 2014 Dec 12.
The phenotype associated to reduced physical activity (PA) in dialysis patients is poorly documented. We here evaluate weekly PA in two independent cohorts.
Cross-sectional study with PA assessed by the number of steps/day measured by pedometer in two cohorts of prevalent dialysis patients: (1) peritoneal dialysis (PD) patients (n = 64; 62 ± 14 years; 70 % men) from Stockholm, Sweden using the pedometer for 7 consecutive days; (2) hemodialysis (HD) patients (n = 78; 63 ± 12 years; 65% men) from a single center in Madrid, Spain using the pedometer for 6 consecutive days: 2 HD days, 2 non-HD midweek days and 2 non-HD weekend days. In both cohorts, comorbidities, body composition, nutritional status, and related biomarkers were assessed. Cohorts were not merged; instead data were analyzed separately serving as reciprocal replication analyses.
Most patients (63% of PD and 71% of HD) were considered sedentary (<5,000 steps/day). PD patients had on average 4,839 ± 3,313 steps/day. HD patients had 3,767 ± 3,370 steps/day on HD-free days, but fewer steps/day on HD days (2,274 ± 2,048 steps/day; p < 0.0001). In both cohorts, and across increasing PA tertiles, patients were younger and had less comorbidities. Higher PA was also accompanied by better nutritional status (depicted by albumin, pre-albumin, creatinine and normalized protein catabolic rate in HD, and by albumin and subjective global assessment [SGA] in PD), higher lean body mass, and lower fat body mass (bioimpedance and/or dual-energy X-ray absorptiometry [DEXA]). Higher levels of PA were accompanied by lower levels of C-reactive protein in PD. Age and lean body mass were the strongest multivariate predictors of PA in both cohorts.
There is a high prevalence of sedentary behavior in dialysis patients. Better physical activity was consistently associated with younger age, lower presence of comorbidities and better nutritional status. Pedometers represent a simple and inexpensive tool to objectively evaluate physical activity in this patient population.
透析患者中与体力活动（PA）减少相关的表型记录较少。我们在此评估两个独立队列中的每周PA情况。
采用横断面研究，通过计步器测量的每日步数评估PA，研究对象为两个队列的透析患者：（1）来自瑞典斯德哥尔摩的腹膜透析（PD）患者（n = 64；62±14岁；70%为男性），连续7天使用计步器；（2）来自西班牙马德里一个中心的血液透析（HD）患者（n = 78；63±12岁；65%为男性），连续6天使用计步器：2个HD日、2个非HD工作日和2个非HD周末日。在两个队列中，评估了合并症、身体成分、营养状况及相关生物标志物。两个队列未合并；而是分别分析数据，作为相互重复分析。
大多数患者（PD患者的63%和HD患者的71%）被认为久坐不动（<5000步/天）。PD患者平均每日步数为4839±3313步。HD患者在非HD日平均每日步数为3767±3370步，但在HD日每日步数较少（2274±2048步/天；p<0.0001）。在两个队列中，且随着PA三分位数的增加，患者年龄更小且合并症更少。更高的PA还伴随着更好的营养状况（HD中用白蛋白、前白蛋白、肌酐和标准化蛋白分解代谢率表示，PD中用白蛋白和主观全面评定[SGA]表示）、更高的瘦体重和更低的脂肪量（生物电阻抗和/或双能X线吸收法[DEXA]）。PD中PA水平较高伴随着C反应蛋白水平较低。年龄和瘦体重是两个队列中PA最强的多变量预测因素。
透析患者久坐行为的患病率很高。更好的体力活动与更年轻的年龄、更低的合并症发生率和更好的营养状况始终相关。计步器是客观评估该患者群体体力活动的一种简单且廉价的工具。
