Impact of type 2 diabetes mellitus on physical activity in pre-dialysis patients with chronic kidney disease
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LETTER TO THE EDITOR
Impact of type 2 diabetes mellitus on physical activity in pre‑dialysis patients with chronic kidney disease Akira Saito1 · Koji Hiraki1 · Yuhei Otobe2 · Kazuhiro P. Izawa3 · Yugo Shibagaki4 Received: 21 April 2020 / Accepted: 14 May 2020 © Japanese Society of Nephrology 2020
To the Editor, Physical activity (PA) is related to slower decline of estimated glomerular filtration rate (eGFR) and lower risk of progression to end-stage kidney disease in patients with chronic kidney disease (CKD) [1]. Generally, patients with diabetes mellitus (DM) tends to have lower PA than those without DM [2]. The number of patients with diabetic nephropathy is increasing, and CKD patients with DM correlate negatively with lower PA levels. However, the association between PA and CKD patients with DM is unknown. This observational study was conducted from September 2011 to May 2015. We enrolled 99 consecutive outpatients visiting a pre-dialysis CKD clinic (median age, 69.0 years; 78.7% men; mean eGFR, 37.9 mL/min/1.73 m2). Patients with type 1 DM, severe neurological and orthopedic disease, and dementia were excluded. Patients were divided into two * Koji Hiraki hiraki7@marianna‑u.ac.jp Akira Saito [email protected] Yuhei Otobe y‑oto@marianna‑u.ac.jp Kazuhiro P. Izawa [email protected]‑u.ac.jp Yugo Shibagaki [email protected] 1
Department of Rehabilitation Center, St. Marianna University School of Medicine Hospital, 2‑16‑1 Sugao, Miyamae‑ku, Kawasaki, Kanagawa, Japan
2
Department of Rehabilitation Medicine, Kawasaki Municipal Tama Hospital, 1‑30‑37 Syukugawara, Tama‑ku, Kawasaki, Japan
3
Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan
4
Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine Hospital, 2‑16‑1 Sugao, Miyamae‑ku, Kawasaki, Kanagawa, Japan
groups based on the presence of DM: CKD patients with DM group (n = 29) and CKD patients without DM group (n = 70). We measured daily number of steps taken (step count) and energy expenditure (EE) on daily PA over 8 days using a Kenz Lifecorder EX uniaxial accelerometer (Suzuken Co., Ltd., Nagoya, Japan). Average daily step count over 1 week (comprising the final 7 days of continuous data from the 8-day collection period) was calculated as total step count over 7 days/7 (steps/day) and average of daily EE as (kcal) expended over 7 days/7 [3]. We reviewed the medical records of the patients to investigate baseline demographic and clinical characteristics including age, sex, body mass index (BMI), eGFR, serum albumin, hemoglobin (Hb), and glycated Hb (HbA1c). The characteristics of the patients are shown in Table 1. We assessed the impact of type 2 DM on step counts and EE with multiple regression analysis. Step counts and EE were the independent variables, diabetes status the dependent variable, and the covariates entered were factors affecting step counts and EE as reported in a previous study of patients with CKD. Ste
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