The Association between Leisure-Time Physical Activity Intensity and Duration with the Risk of Mortality in Patients with Chronic Kidney Disease with or without Cardiovascular Diseases.

INTRODUCTION

For chronic kidney disease (CKD) patients with or without cardiovascular diseases, the associations between leisure-time physical activity intensity (LTPA) and daily exercise time with mortality risk remain unclear.

METHOD

This study enrolled 3279 CKD patients from National Health and Nutrition Examination Survey (NHANES) 2007-2014 survey. Patients were grouped into different groups according to LTPA intensity (none, moderate, vigorous) and duration (0 min, 0-30 min, 30-60 min, 60 min). We selected the confounders based on their connections with the outcomes of interest or a change in effect estimate of more than 10%. Multivariable-adjusted Cox proportional hazards models were used to examine the associations between LTPA and mortality. The three-knot cubic spline (10, 50, and 90%) was employed to investigate the relationship between the dose of LTPA duration and all-cause death. Patients were divided into different groups according to cardiovascular diseases (CVD).

RESULTS

A total of 564 all-cause death were recorded in this study. Multivariable Cox regression showed that moderate LTPA was associated with a reduced risk of mortality by 38% (hazard ratio (HR): 0.62, 95% confidence interval (CI): 0.44-0.88) in CKD patients, while vigorous LTPA did not have evident survival benefits (HR: 0.91, 95% CI: 0.46-2.64). Subgroups analysis demonstrated that those who engaged in moderate LTPA have a significantly lower risk of mortality (HR: 0.67, 95% CI: 0.47-0.95) in patients without CVD, while patients complicated with CVD did not benefit from the practice (HR: 0.61, 95% CI: 0.37-1.02). Physical exercise for more than 30 minutes was associated with a lower risk of mortality in general CKD patients (30-60 min: HR: 0.23, 95% CI: 0.09-0.58, 60 min: HR: 0.23, 95% CI: 0.08-0.63) and those without CVD (30-60 min/d: HR: 0.32, 95% CI: 0.12-0.83, 60 min/d: HR: 0.20, 95% CI: 0.06-0.71); however, this positive outcome was not seen in patients complicated with CVD (30-60 min/d: HR: 0.67, 95% CI: 0.11-4.04, 60 min/d: HR: 1.14, 95% CI: 0.14-9.11).

CONCLUSIONS

Moderate LTPA for more than 30 minutes is associated with a reduced risk of mortality in general CKD patients and those without CVD. However, LTPA did not reduce the risk of mortality in CKD patients complicated with CVD.