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Abstract
The association of physical activity with renal outcome and mortality in advanced chronic kidney disease (CKD; i.e., estimated glomerular filtration rate [eGFR] < 45 ml/min/1.73m2) is poorly studied. We examined this association in patients with advanced CKD in Japan. We used the Rapid Assessment of Physical Activity to assess baseline physical activity and classify patients as active or inactive. CKD progression was defined as 40% decline in eGFR, eGFR < 10, or requiring dialysis or transplantation. Among the 1,808 eligible patients, after adjusting for possible confounders, hazard ratios (HRs) for poor renal outcome in the active group were 0.68 (95% CI, 0.44–1.04), 1.09 (0.86–1.38), and 1.01 (0.82–1.25) in CKD stage G3b, G4, and G5, respectively, suggesting a renal benefit of exercise in CKD stage G3b. Adjusted HRs for death were 0.79 (0.40–1.57), 0.55 (0.38–0.80), and 0.75 (0.44–1.26) in stage G3b, G4, and G5, respectively. While the adjusted HRs of death were 0.84 (0.52–1.38) and 0.60 (0.43–0.83) in diabetic and non-diabetic patients, suggesting that exercise may reduce mortality in non-diabetic patients. Our study suggests that exercise is associated with better survival in non-diabetic patients with CKD stage G3b-5, and better renal outcome in diabetic and non-diabetic CKD stage G3b.
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1 Tokyo Women’s Medical University, Department of Nephrology, Tokyo, Japan (GRID:grid.410818.4) (ISNI:0000 0001 0720 6587); University of Tsukuba, Department of Nephrology, Faculty of Medicine, Institute of Medicine, Tsukuba, Japan (GRID:grid.20515.33) (ISNI:0000 0001 2369 4728)
2 University of Tsukuba, Tsukuba Clinical Research and Development Organization (T-CReDO), Tsukuba, Japan (GRID:grid.20515.33) (ISNI:0000 0001 2369 4728)
3 University of Tsukuba, Department of Nephrology, Faculty of Medicine, Institute of Medicine, Tsukuba, Japan (GRID:grid.20515.33) (ISNI:0000 0001 2369 4728)
4 University of Tsukuba, Ibaraki Clinical Education and Training Center, Institute of Medicine, Tsukuba, Japan (GRID:grid.20515.33) (ISNI:0000 0001 2369 4728); Ibaraki Prefectural Central Hospital, Department of Nephrology, Kasama, Japan (GRID:grid.414493.f) (ISNI:0000 0004 0377 4271)
5 Saitama Medical University, Department of Nephrology, Saitama, Japan (GRID:grid.410802.f) (ISNI:0000 0001 2216 2631)
6 Niigata Institute for Health and Sports Medicine, Niigata, Japan (GRID:grid.410802.f)
7 Kanazawa University, Department of Nephrology and Rheumatology, Ishikawa, Japan (GRID:grid.9707.9) (ISNI:0000 0001 2308 3329)
8 Nagoya University, Department of Nephrology, Nagoya, Japan (GRID:grid.27476.30) (ISNI:0000 0001 0943 978X)
9 Arbor Research Collaborative for Health, Ann Arbor, USA (GRID:grid.413857.c) (ISNI:0000 0004 0628 9837)