Shohei Yamamoto1, Ryota Matsuzawa2, Yoshifumi Abe1,3, Keika Hoshi4, Kei Yoneki1, Manae Harada1, Takaaki Watanabe1, Takahiro Shimoda1, Yuta Suzuki1, Yusuke Matsunaga5, Kentaro Kamiya1,6, Atsushi Yoshida7, Atsuhiko Matsunaga8,9. 1. Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan. 2. Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan. 3. Division of Rehabilitation, Mitsui Memorial Hospital, Tokyo, Japan. 4. Department of Hygiene, Kitasato University School of Medicine, Sagamihara, Japan. 5. Department of Sleep Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan. 6. Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan. 7. Department of Hemodialysis Center, Sagami Circulatory Organ Clinic, Sagamihara, Japan. 8. Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japanatsuhikonet@gmail.com. 9. Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japanatsuhikonet@gmail.com.
Abstract
BACKGROUND/AIMS: Several clinical practice guidelines recommend regular assessment of physical activity and physical function as part of routine care in hemodialysis patients. However, there is no clear evidence to support these recommendations. We investigated whether the proportion of attendance at a regular program for management of physical activity and physical function can predict all-cause mortality and cardiovascular events in hemodialysis patients. METHODS: This retrospective cohort study consisted of 266 hemodialysis patients participating in the management program at least once. Participants were tracked for 3 years after their first attendance at the management program to determine their attendance proportion. The main study outcomes included all-cause mortality and a composite of fatal and nonfatal cardiovascular events. RESULTS: Median patient age was 64.5 (interquartile range, 56.8 - 72.0) years, 45% were women, and the median time on hemodialysis was 35.5 (interquartile range, 12.0 - 114.3) months at baseline. Sixty-five patients died over a median follow-up of 79 months. The incidence of cardiovascular events was 60 over a median follow-up of 68 months. Even after adjusting for any of the prognostic models, participants who attended ≤ 75% of sessions (n = 140) had higher risks of mortality (hazard ratio (HR), 1.79; 95% confidence interval (CI): 1.00 - 3.36; P = 0.049) and cardiovascular events (HR, 1.84; 95% CI: 1.07 - 3.48; P = 0.03) than those attending > 75% of sessions (n = 126). CONCLUSION: Hemodialysis patients in whom physical activity and physical function could be assessed more regularly had better prognosis than those with only intermittent assessment.
BACKGROUND/AIMS: Several clinical practice guidelines recommend regular assessment of physical activity and physical function as part of routine care in hemodialysis patients. However, there is no clear evidence to support these recommendations. We investigated whether the proportion of attendance at a regular program for management of physical activity and physical function can predict all-cause mortality and cardiovascular events in hemodialysis patients. METHODS: This retrospective cohort study consisted of 266 hemodialysis patients participating in the management program at least once. Participants were tracked for 3 years after their first attendance at the management program to determine their attendance proportion. The main study outcomes included all-cause mortality and a composite of fatal and nonfatal cardiovascular events. RESULTS: Median patient age was 64.5 (interquartile range, 56.8 - 72.0) years, 45% were women, and the median time on hemodialysis was 35.5 (interquartile range, 12.0 - 114.3) months at baseline. Sixty-five patients died over a median follow-up of 79 months. The incidence of cardiovascular events was 60 over a median follow-up of 68 months. Even after adjusting for any of the prognostic models, participants who attended ≤ 75% of sessions (n = 140) had higher risks of mortality (hazard ratio (HR), 1.79; 95% confidence interval (CI): 1.00 - 3.36; P = 0.049) and cardiovascular events (HR, 1.84; 95% CI: 1.07 - 3.48; P = 0.03) than those attending > 75% of sessions (n = 126). CONCLUSION: Hemodialysis patients in whom physical activity and physical function could be assessed more regularly had better prognosis than those with only intermittent assessment.