P212
PHYSICAL CAPACITY AND EXERCISE PATTERNS IN CHRONIC
KIDNEY DISEASE VARY DEPENDING ON PRESENCE OR ABSENCE OF
MEDICAL CO-MORBIDITY
Graham-Brown MPM1, Clarke AL1,2, Hull KL1,2, John, SG3, Smith AC1,2, Burton
JO,1,2
Leicester Kidney Exercise Team, John Walls’ Renal Unit, University Hospitals of
Leicester NHS Trust, Leicester, UK
2
Department of Infection, Immunity & Inflammation, University of Leicester,
Leicester, UK.
3
Department of Renal Medicine, Royal Derby Hospital, Derby, UK.
1
INTRODUCTION: Physical inactivity has been described by some as ‘the greatest
public health threat in today’s society’. Patients with chronic kidney disease (CKD)
are known to experience significant physical decline as their condition progresses and
there is a gathering body of evidence to suggest that exercise is beneficial for patients
with CKD. In addition, increased physical activity levels have been shown to impact
positively upon many cardiovascular risk factors including obesity, dyslipidemia,
hypertension, insulin resistance, systemic inflammation and loss of muscle mass.
However, neither the patterns of exercise and activity levels amongst patients with
CKD, nor the barriers to exercise that these patients experience are well understood.
PURPOSE: This study aimed to explore differences in functional capacity and
exercise patterns between patients with CKD plus diabetes and/or cardiovascular
disease (CVD) and patients with CKD alone.
METHODS: Epidemiological data was collected prospectively on patients attending
renal out-patient clinics at two hospital sites (total number of patients 919).
Information on blood biochemistry and co-morbidities, were extracted from clinical
records with informed consent, and patients also completed questionnaires related to
activity and exercise levels: the Duke Activity Status Index (DASI) and the Leisure
Time Exercise Questionnaire (LTEQ). Higher scores in these questionnaires indicate
higher levels of functional capacity and exercise behaviour respectively.
RESULTS: Out of a total of 919 patients recruited, 797 had complete data sets and
were included in the analysis. Of those, 346 patients were in the group with CKD
plus diabetes and/or CVD and 451 patients in the group with CKD alone. Univariate
analysis, revealed differences between age (mean 69.6 (range 17-99) vs 56.8 (range
17-93) years P<0.001); eGFR (mean 31.7 (range 5-90) vs 43.9 (range 5-90)
ml/min/1.73m2 , P<0.001) and both physical capacity and activity levels (median
DASI score 18.95 (range 0.0-58.2) vs 40.95 (range 0.0-58.2) and median LETQ score
3 (range 0.0-238) vs 12 (range 0-155); P<0.001 for both). Multivariate linear
regression analysis showed that after adjustment, all three variables; age, eGFR and
the presence of diabetes and/or CVD were independent predictors of lower functional
capacity and physical activity levels (P<0.001 R2=0.3).
CONCLUSIONS: This study shows significantly lower levels of activity and
exercise amongst patients with CKD plus diabetes and/or CVD compared to patients
with CKD alone. Given that physical inactivity is an important modifiable
cardiovascular risk factor, and in a time of limited resources, strategies aimed at
increasing physical activity should initially be aimed at those most at risk of
cardiovascular events.