Impact of hemodialysis and post-dialysis period on granular activity levels

John W Larkin, Maggie Han, Hao Han, Murilo H Guedes, Priscila Bezerra Gonçalves, Carlos Eduardo Poli-de-Figueiredo, Américo Lourenço Cuvello-Neto, Ana Beatriz L Barra, Thyago Proença de Moraes, Len A Usvyat, Peter Kotanko, Maria Eugenia F Canziani, Jochen G Raimann, Roberto Pecoits-Filho, HDFIT Study Investigators, Ana Claudia Dambiski, Thaylane Amanda de Souza, Daniela Ponce, Edwa Maria Bucuvic, Luciana Menin Ferreira, Wanderson de Souza Carvalho, Jorge Paulo Strogoff de Matos, Esther Oliveria Silva, Manuel Carlos Martins de Castro, Celina de Fátima E Silva, Maria Eugenia F Canziani, Silvia R Manfredi, Katia Santos, Ana Paula Fonseca Correia, Giovani Gadonski, Adriana Conti, Inah Pecly, Camille Souza Paixão, Viviane Calice-Silva, Simone Ribeiro, Lizia Regina Ribeiro Caldeira, Adailto Santos, Rosilene Motta Elias, Andreia Barbosa Dos Santos, Américo Lourenço Cuvello-Neto, Amanda Monteiro Virolli, John W Larkin, Maggie Han, Hao Han, Murilo H Guedes, Priscila Bezerra Gonçalves, Carlos Eduardo Poli-de-Figueiredo, Américo Lourenço Cuvello-Neto, Ana Beatriz L Barra, Thyago Proença de Moraes, Len A Usvyat, Peter Kotanko, Maria Eugenia F Canziani, Jochen G Raimann, Roberto Pecoits-Filho, HDFIT Study Investigators, Ana Claudia Dambiski, Thaylane Amanda de Souza, Daniela Ponce, Edwa Maria Bucuvic, Luciana Menin Ferreira, Wanderson de Souza Carvalho, Jorge Paulo Strogoff de Matos, Esther Oliveria Silva, Manuel Carlos Martins de Castro, Celina de Fátima E Silva, Maria Eugenia F Canziani, Silvia R Manfredi, Katia Santos, Ana Paula Fonseca Correia, Giovani Gadonski, Adriana Conti, Inah Pecly, Camille Souza Paixão, Viviane Calice-Silva, Simone Ribeiro, Lizia Regina Ribeiro Caldeira, Adailto Santos, Rosilene Motta Elias, Andreia Barbosa Dos Santos, Américo Lourenço Cuvello-Neto, Amanda Monteiro Virolli

Abstract

Background: Physical activity (PA) is typically lower on hemodialysis (HD) days. Albeit intradialytic inactivity is expected, it is unknown whether recovery after HD contributes to low PA. We investigated the impact of HD and post-HD period on granular PA relative to HD timing.

Methods: We used baseline data from the HDFIT trial conducted from August 2016 to October 2017. Accelerometry measured PA over 1 week in patients who received thrice-weekly high-flux HD (vintage 3 to 24 months), were clinically stable, and had no ambulatory limitations. PA was assessed on HD days (0 to ≤24 h after start HD), first non-HD days (> 24 to ≤48 h after start HD) and second non-HD day (> 48 to ≤72 h after start HD). PA was recorded in blocks/slices: 4 h during HD, 0 to ≤2 h post-HD (30 min slices), and > 2 to ≤20 h post-HD (4.5 h slices). Blocks/slices of PA were captured at concurrent/parallel times on first/second non-HD days compared to HD days.

Results: Among 195 patients (mean age 53 ± 15 years, 71% male), step counts per 24-h were 3919 ± 2899 on HD days, 5308 ± 3131 on first non-HD days (p < 0.001), and 4926 ± 3413 on second non-HD days (p = 0.032). During concurrent/parallel times to HD on first and second non-HD days, patients took 1308 and 1128 more steps (both p < 0.001). Patients took 276 more steps and had highest rates of steps/hour 2-h post-HD versus same times on first non-HD days (all p < 0.05). Consistent findings were observed on second non-HD days.

Conclusions: PA was higher within 2-h of HD versus same times on non-HD days. Lower PA on HD days was attributable to intradialytic inactivity. The established PA profiles are of importance to the design and development of exercise programs that aim to increase activity during and between HD treatments.

Trial registration: HDFIT was prospectively registered 20 April 2016 on ClinicalTrials.gov (NCT02787161).

Keywords: Accelerometry; End stage kidney disease; High-flux hemodialysis; Moderate-to-vigorous activity; Physical activity; Steps.

Conflict of interest statement

JWL, MH, MG are students at Pontifícia Universidade Católica do Paraná. JWL, HH, LAU, are employees of Fresenius Medical Care. MH, PK, JGR are employees of Renal Research Institute, a wholly owned subsidiary of Fresenius Medical Care North America. PBG receives travel support from Fresenius Medical Care. CEPF, ALCN receive consulting fees and speaker honorarium from Fresenius Medical Care. CEPF receives lecture fees and travel support from Fresenius Medical Care, Alexion, Baxter, and Astra Zeneca, and is employed by Pontifícia Universidade Católica do Rio Grande do Sul. ABLB is an employee of Fresenius Medical Care Brazil. LAU, PK have share options/ownership in Fresenius Medical Care. PK receives author honorarium from Up-To-Date and is on the Editorial Board of Blood Purification and Kidney and Blood Pressure Research. RPF, TPM are employed by Pontifícia Universidade Católica do Paraná. RPF, CEPF, TPM, MEFC are recipients of scholarships from the Brazilian Council for Research (CNPq). MEFC is employee by Federal University of São Paulo, and receives research grants, consulting fees, and honoraria from Baxter Healthcare and Fresenius Medical Care. RPF is employed by Arbor Research Collaborative for Health, and receives research grants, consulting fees, and honoraria from Astra Zeneca, Novo Nordisc, Akebia, and Fresenius Medical Care. All other authors declare no relevant conflicts of interest.

Figures

Fig. 1
Fig. 1
Schematic of the design for the export and analysis of physical activity levels in in reference to the timing of the start of HD, or concurrent/parallel times on non-HD days. Data was capture over 24 h periods in 3 blocks. The blocks were sliced to periods to investigate granular profiles after HD
Fig. 2
Fig. 2
Participant Flow Diagram
Fig. 3
Fig. 3
Normalized rates for steps per hour with 95% confidence intervals in the prespecified periods 0-to- ≤ 24 h after the start of HD on HD days (solid gray columns), > 24-to- ≤ 48 h after the start of HD on the first non-HD days (white with black doted columns), and > 48-to- ≤ 72 h after the start of HD on the second non-HD day (horizontal black striped columns). Times during and post-HD/concurrent periods are presented on the x axis and the rate of steps per hour is shown on the y-axis
Fig. 4
Fig. 4
Normalized rates for minutes of MVPA per hour with 95% confidence intervals in the prespecified periods 0-to- ≤ 24 h after the start of HD on HD days (solid gray columns), > 24-to- ≤ 48 h after the start of HD on the first non-HD days (white with black doted columns), and > 48-to- ≤ 72 h after the start of HD on the second non-HD day (horizontal black striped columns). Times during and post-HD/concurrent periods are presented on the x axis and the rate of MVPA per hour is shown on the y-axis

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