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Association of self-reported physical function with survival in patients with chronic kidney disease

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posted on 2018-08-17, 12:37 authored by Amy L. Clarke, Francesco Zaccardi, Douglas W. Gould, Katherine L. Hull, Alice C. Smith, James O. Burton, Thomas Yates
Background: Reduced physical function is associated with an increased risk of mortality among CKD patients not requiring renal replacement therapy (RRT). Assessments of physical performance can help to identify those at risk for adverse events. However, objective measures are not always feasible and self-reported measures may provide a suitable surrogate. Methods: A cohort study examining associations between self-reported physical function and walking behaviour with survival in patients with CKD not requiring RRT. Data were analysed from the QCKD study (ISRCTN 87066351), a prospective observational mixed methods study of physical activity in patients with CKD. 450 CKD patients not requiring RRT, aged 17-93 years, were followed up for a median of 43 months. Upon enrolment, participants completed two questionnaires: Duke Activity Status Index (DASI) (physical function) and GP Physical Activity Questionnaire (habitual activity). Mortality data were collected from electronic records in September 2016; RRT was considered a competing event. Results: A total of 74 deaths occurred during follow-up and 101 participants were started on RRT. The adjusted subdistribution hazard ratio (SHR) of mortality in participants scoring >19.2 on DASI was 0.51 (95% CI, 0.30-0.88) while a 1-unit increase in DASI was associated with SHR 0.97 (0.95-0.99). The adjusted SHRs of mortality were 0.48 (0.26-0.90), 0.25 (0.11-0.57), and 0.48 (0.23-0.80) for participants walking <1, 1-3 and ≥3 hours per week, 3 respectively, compared to no walking. Walking pace >3mph was associated with reduced risk of mortality [SHR 0.37 (0.20-0.71)] compared to walking pace <3mph. Conclusions: Physical function and walking behaviours were independently associated with survival in CKD and may help to identify patients at risk for adverse events.

Funding

This work is independent research funded by a 2011 British Renal Society/British Kidney Patient Association Research Grant and the Stoneygate Trust. Amy Clarke was partly supported by a Kidney Research UK Innovation Grant (IN7/2014), James Burton is supported by a National Institute for Health Research Clinician Scientist Award (CS-2013- 13-014) and Katherine Hull received a Kidney Research UK Medical Student Bursary for 2012-2013. The authors gratefully acknowledge the generous funding of all the above organisations. The research was supported by the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Francesco Zaccardi is funded with an unrestricted educational grant from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands to the University of Leicester.

History

Citation

Clinical Kidney Journal, 2018, sfy080

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Infection, Immunity and Inflammation

Version

  • VoR (Version of Record)

Published in

Clinical Kidney Journal

Publisher

Oxford University Press (OUP) for European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)

issn

2048-8505

eissn

2048-8513

Acceptance date

2018-07-13

Copyright date

2018

Available date

2018-09-07

Publisher version

https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfy080/5086071

Language

en

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