Physical Activity and Rapid Decline in Kidney Function Among Older Adults

Department of Epidemiology, University of Washington, Seattle, 98195, USA.
Archives of internal medicine (Impact Factor: 17.33). 12/2009; 169(22):2116-23. DOI: 10.1001/archinternmed.2009.438
Source: PubMed


Habitual physical activity (PA) has both physiologic and metabolic effects that may moderate the risk of kidney function decline. We tested the hypothesis that higher levels of PA are associated with a lower risk of kidney function decline using longitudinal data from a large cohort of older adults.
We studied 4011 ambulatory participants aged 65 or older from the Cardiovascular Health Study (CHS) who completed at least 2 measurements of kidney function over 7 years. We calculated a PA score (range, 2-8) by summing kilocalories expended per week (ordinal score of 1-5 from quintiles of kilocalories per week) and walking pace (ordinal score for categories of <2, 2-3, and >3 mph). Rapid decline in kidney function decline (RDKF) was defined by loss of more than 3.0 mL/min/1.73 m(2) per year in glomerular filtration rate, which we estimated by using longitudinal measurements of cystatin C levels.
A total of 958 participants had RDKF (23.9%; 4.1 events per 100 person-years). The estimated risk of RDKF was 16% in the highest PA group (score of 8) and 30% in the lowest PA group (score of 2). After multivariate adjustment, we found that the 2 highest PA groups (scores of 7-8) were associated with a 28% lower risk of RDKF (95% confidence interval, 21%-41% lower risk) than the 2 lowest PA groups (score of 2-3). Greater kilocalories of leisure-time PA and walking pace were also each associated with a lower incidence of RDKF.
Higher levels of PA are associated with a lower risk of RDKF among older adults.

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Available from: Cassianne Robinson-Cohen, Jan 15, 2014
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    • "A recent Cochrane review has highlighted the potential positive effects of regular leisure exercise on advanced CKD mainly through the improvement of cardiovascular risk (diabetes, high blood pressure) [11] [12] [13] [14] and aerobic capacity [11]. However, the effect of physical activity on early stages of CKD is not well-established [12], and few studies have focused specifically on it [15] [16] [17]. The eGFR is one of the essential determinants that characterize CKD. "
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    ABSTRACT: Chronic kidney disease is now regarded as a risk factor for cardiovascular disease. The impact of occupational or non-occupational physical activity (PA) on moderate decreases of renal function is uncertain. We aimed to identify the potential association of PA (occupational and leisure-time) on early decline of estimated glomerular filtration rate (eGFR) and to determine the potential mediating effect of PA on the relationship between eGFR and heart disease. From the PRIME study analyses were conducted in 1058 employed men. Energy expended during leisure, work and commuting was calculated. Linear regression analyses were used to determine the link between types of PA and moderate decrements of eGFR determined with the KDIGO guideline at the baseline assessment. Cox proportional hazards analyses were used to explore the potential effect of PA on the relationship between eGFR and heart disease, ascertained during follow-up over 10years. For these employed men, and after adjustment for known confounders of GFR change, more time spent sitting at work was associated with increased risk of moderate decline in kidney function, while carrying objects or being active at work was associated with decreased risk. In contrast, no significant link with leisure PA was apparent. No potential mediating effect of occupational PA was found for the relationship between eGFR and coronary heart disease. Occupational PA (potential modifiable factors) could provide a dual role on early impairment of renal function, without influence on the relationship between early decrease of e-GFR and CHD risk. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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    • "In the present study daily physical activity was positively correlated with creatinine clearance. Indeed, previous studies have shown that habitual physical activity was positively associated with renal function [31–33]. Why decrease in creatinine clearance was associated with decreased physical activity? "
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    ABSTRACT: The present study was carried out to investigate independent relationship between daily physical activity, microalbuminuria, and kidney function. The demographic characteristics and laboratory parameters were recorded for all patients. The determination of daily activities was carried out by Nottingham Extended Activities of Daily Living Scale (NEADLS) which was performed for each patient in an interview. Totally 139 patients were enrolled. In the whole group NEADLS score was correlated with age (rho: -0.759, P < 0.0001), clinical systolic blood pressure (rho: -0.212, P: 0.018), blood urea nitrogen (rho: -0.516, P < 0.0001), creatinine (rho: -0.501, P < 0.0001), uric acid (rho: -0.308, P < 0.0001), albumin (rho: 0.382, P < 0.0001), total cholesterol (rho: -0.194, P: 0.022), LDL-cholesterol (rho: -0.230, P: 0.008), hemoglobin (rho: 0.256, P: 0.002), creatinine clearance (rho: 0.565, P < 0.0001), 24-hour urinary protein excretion (rho: -0.324, P < 0.0001), and 24-hour urinary albumin excretion (UAE) (rho: -0.483, P < 0.0001). The multivariate linear regression of independent factors corelated with logarithmically converted NEADLS score (as a dependent variable) has shown that age (P < 0.0001), presence of coronary artery disease (P: 0.011), hemoglobin (P: 0.020), 24-hour creatinine clearance (P: 0.004), and 24-hour urinary albumin excretion (P < 0.0001) were independently corelated with NEADLS score. In conclusion, both UAE and kidney function were independently associated with daily physical activity.
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    • "Both low VO 2peak and physical inactivity have been identifi ed as strong independent risk factors for CV morbidity and mortality in the general population (Myers et al., only adjusted for age, gender, and race, indicating that perhaps PA becomes a more important determinant of renal function in people with CVD and diabetes, which are common occurrence in the CKD population (Stengel et al., 2003). In a different longitudinal cohort study, more than 4,000 people older than 65 years of age were followed for 7 years and had at least two measures of kidney function analyzed as well as detailed information on type and amount of PA collected (Robinson-Cohen et al., 2009). This study reported that people who were in the highest PA group and spent more than 2,000 kcal/week on PA had the greatest reductions in the risk of rapid kidney function decline (RKFD) by 25%–37%. "
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    ABSTRACT: Chronic kidney disease (CKD) is becoming a serious health problem throughout the world and is one of the most potent known risk factors for cardiovascular disease (CVD) which is considered the leading cause of morbidity and mortality in this cohort of patients. Additional independent risk factors for poor health outcomes among many include diabetes, physical inactivity and physical dysfunction. Physical inactivity partly contributes to the accelerated deterioration of physical function in people in all stages of CKD, to levels that significantly impact on clinically and patient important outcomes such as morbidity, employment, quality of life (QoL) and ultimately survival. Ongoing research aims to determine the effectiveness and impact of exercise rehabilitation on reducing/managing the risk of CVD, alleviating physical function limitations, preventing disability and enhancing QoL. Current research also aims to elucidate the mechanisms via which exercise therapy may contribute to clinically relevant benefits.
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