Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA.
Fresenius Kidney Care, El Centro, California, USA.
Hemodial Int. 2021 Apr;25(2):240-248. doi: 10.1111/hdi.12913. Epub 2021 Mar 1.
The physical decline in patients with end-stage kidney disease (ESKD) is associated with morbidity and mortality. Prior studies have attempted to promote physical activity at the time of dialysis; however, physical activity patterns on the nondialysis days are unknown. This study aimed to quantify physical activity on dialysis and nondialysis days in hemodialysis patients using a wearable actigraph.
In this prospective study, subjects receiving hemodialysis were recruited from two outpatient dialysis units in urban San Diego and rural Imperial County, CA, between March 2018 and April 2019. Key inclusion criteria included: (1) receiving thrice weekly hemodialysis for ≥3 months, (2) age ≥ 18 years, and (3) able to walk with or without assistive devices. All participants wore a Fitbit Charge 2 tracker for a minimum of 4 weeks. The primary outcome was the number of steps per day. Each participant completed the Physical Activity Questionnaire, the Patient Health Questionnaire (PHQ)-9, the PROMIS Short form Fatigue Questionnaire at baseline, and the Participant Technology Experience Questionnaire at day 7 after study enrolment.
Of the 52 recruited, 45 participants (urban = 25; rural = 20) completed the study. The mean age was 61 ± 15 years, 42% were women, 64% were Hispanic, and the mean dialysis vintage was 4.4 ± 3.0 years. For those with valid Fitbit data (defined as ≥10 hours of wear per day) for 28 days (n = 45), participants walked an average of 3688 steps per day, and 73% of participants were sedentary (<5000 steps/day). Participants aged >80 years were less active than younger (age < 65 years) participants (1232 vs. 4529 steps, P = 0.01). There were no statistical differences between the groups when stratified by gender (women vs. men [2817 vs. 4324 steps, respectively]), urbanicity (rural vs. urban dialysis unit [3141 vs. 4123 steps, respectively]), and dialysis/nondialysis day (3177 vs. 4133 steps, respectively). Due to the small sample size, we also calculated effect sizes. The effect size was medium for the gender differences (cohen's d = 0.57) and small to medium for urbanicity and dialysis/nondialysis day (d = 0.37 and d = 0.33, respectively). We found no association between physical activity and self-reported depression and fatigue scale. The majority of participants (62%, 28/45) found the Fitbit tracker easy to wear and comfortable.
ESKD participants receiving hemodialysis are frequently sedentary, and differences appear more pronounced in older patients. These findings may assist in designing patient-centered interventions to increase physical activity among hemodialysis patients.
终末期肾病（ESKD）患者的身体衰退与发病率和死亡率有关。先前的研究试图在透析时促进身体活动；然而，透析日之外的身体活动模式尚不清楚。本研究旨在使用可穿戴活动记录仪量化血液透析患者在透析日和非透析日的身体活动。
在这项前瞻性研究中，从加利福尼亚州圣地亚哥市的两个门诊透析单位和帝国县的农村地区招募了正在接受血液透析的患者。主要纳入标准包括：（1）每周接受三次血液透析≥3 个月，（2）年龄≥18 岁，以及（3）能够行走或使用辅助设备。所有参与者都佩戴 Fitbit Charge 2 追踪器至少 4 周。主要结局是每天的步数。每位参与者在基线时完成体力活动问卷、患者健康问卷（PHQ-9）、PROMIS 简短疲劳问卷，以及在研究入组后第 7 天完成参与者技术体验问卷。
在招募的 52 名患者中，有 45 名（城市=25；农村=20）完成了研究。平均年龄为 61±15 岁，42%为女性，64%为西班牙裔，平均透析时间为 4.4±3.0 年。对于那些在 28 天内有有效 Fitbit 数据（定义为每天佩戴≥10 小时）的患者（n=45），参与者平均每天行走 3688 步，73%的参与者久坐不动（<5000 步/天）。年龄>80 岁的参与者比年龄较轻的参与者（<65 岁）活动量更少（1232 步与 4529 步，P=0.01）。按性别（女性与男性[分别为 2817 步与 4324 步]）、城乡（农村与城市透析单位[分别为 3141 步与 4123 步]）和透析/非透析日（分别为 3177 步与 4133 步）分层时，两组之间无统计学差异。由于样本量较小，我们还计算了效应量。性别差异的效应量为中等（cohen's d=0.57），城乡和透析/非透析日的效应量为小到中等（d=0.37 和 d=0.33）。我们没有发现身体活动与自我报告的抑郁和疲劳量表之间存在关联。大多数参与者（62%，28/45）发现 Fitbit 追踪器易于佩戴和舒适。
接受血液透析的终末期肾病患者经常久坐不动，且在老年患者中差异更为明显。这些发现可能有助于设计以患者为中心的干预措施，以增加血液透析患者的身体活动。
