Physical activity in patients with pre-dialysis chronic kidney disease is related to physical function
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LETTER TO THE EDITOR
Physical activity in patients with pre‑dialysis chronic kidney disease is related to physical function Chiharu Hotta1 · Koji Hiraki1 · Kazuhiro P. Izawa2 · Tsutomu Sakurada3 · Yugo Shibagaki3 Received: 18 June 2020 / Accepted: 20 July 2020 © Japanese Society of Nephrology 2020
Keywords Physical activity · Chronic kidney disease · Physical function To the Editor Physical activity (PA) is associated with renal function and mortality in patients with pre-dialysis chronic kidney disease (CKD) [1–3]. A previous study suggested that higher levels of PA are associated with a lower prevalence of CKD [4]. Although some studies have objectively characterized PA in pre-dialysis CKD, few have assessed objective parameters of PA such as a number of steps or exercise energy expenditure. Further, factors relevant to PA remain unclear in patients with pre-dialysis CKD. Thus, we aimed to measure PA objectively and investigate factors related to PA in patients with pre-dialysis CKD. The participants included 168 outpatients with pre-dialysis CKD stage G2–5 who could ambulate to our nephrology clinic. There were 125 men and 43 women (average age, 73.1 ± 9.2 years) with a mean estimated glomerular filtration rate (eGFR) of 35.3 ± 15.9 mL/min/1.73 m2. We investigated patient characteristics including age, sex, body mass index (BMI), primary kidney disease, presence of diabetes, employment status, and biochemical parameters including eGFR, hemoglobin (Hb), albumin, C-reactive protein, and urinary protein (UP) from the medical records. Knee extensor muscle strength, handgrip strength, and one-leg standing time were measured and evaluated according to our * Koji Hiraki hiraki7@marianna‑u.ac.jp 1
Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, 2‑16‑1 Sugao, Miyamae‑ku, Kawasaki, Kanagawa 216‑8511, Japan
2
Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan
3
Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
previous study [5]. We also assessed PA, defined as average daily energy expenditure on exercise and the average daily number of steps taken, using an accelerometer-pedometer. The patients were divided into three groups based on eGFR: stage 2 and 3a groups (n = 46), stage 3b group (n = 55), and stage 4 and 5 groups (n = 67). One-way analysis of covariance was used to test for differences in PA between the three groups. The relation between PA and the variables was analyzed by Spearman’s partial correlation coefficients. Stepwise multiple regression analysis was conducted using factors showing a single correlation as independent variables and PA as the dependent variable. In stage 2 and 3a, stage 3b, and stage 4 and 5 groups, exercise energy expenditures were 197.8 ± 97.6, 129.6 ± 85.2, and 110.7 ± 61.8 kcal/day, and numbers of steps were 6815.8 ± 2659.9, 5134.2 ± 2779.3, and 4755.6 ± 2365.5 steps/day, respectively (Fig. 1). Exe
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