Physical performance and clinical outcomes in dialysis patients: a secondary analysis of the EXCITE trial
Claudia Torino, Fabio Manfredini, Davide Bolignano, Filippo Aucella, Rossella Baggetta, Antonio Barillà, Yuri Battaglia, Silvio Bertoli, Graziella Bonanno, Pietro Castellino, Daniele Ciurlino, Adamasco Cupisti, Graziella D'Arrigo, Luciano De Paola, Fabrizio Fabrizi, Pasquale Fatuzzo, Giorgio Fuiano, Luigi Lombardi, Gaetano Lucisano, Piergiorgio Messa, Renato Rapanà, Francesco Rapisarda, Stefania Rastelli, Lisa Rocca-Rey, Chiara Summaria, Alessandro Zuccalà, Giovanni Tripepi, Luigi Catizone, Carmine Zoccali, Francesca Mallamaci, EXCITE Working Group, Claudia Torino, Fabio Manfredini, Davide Bolignano, Filippo Aucella, Rossella Baggetta, Antonio Barillà, Yuri Battaglia, Silvio Bertoli, Graziella Bonanno, Pietro Castellino, Daniele Ciurlino, Adamasco Cupisti, Graziella D'Arrigo, Luciano De Paola, Fabrizio Fabrizi, Pasquale Fatuzzo, Giorgio Fuiano, Luigi Lombardi, Gaetano Lucisano, Piergiorgio Messa, Renato Rapanà, Francesco Rapisarda, Stefania Rastelli, Lisa Rocca-Rey, Chiara Summaria, Alessandro Zuccalà, Giovanni Tripepi, Luigi Catizone, Carmine Zoccali, Francesca Mallamaci, EXCITE Working Group
Abstract
Background/aims: Scarce physical activity predicts shorter survival in dialysis patients. However, the relationship between physical (motor) fitness and clinical outcomes has never been tested in these patients.
Methods: We tested the predictive power of an established metric of motor fitness, the Six-Minute Walking Test (6MWT), for death, cardiovascular events and hospitalization in 296 dialysis patients who took part in the trial EXCITE (ClinicalTrials.gov Identifier: NCT01255969).
Results: During follow up 69 patients died, 90 had fatal and non-fatal cardiovascular events, 159 were hospitalized and 182 patients had the composite outcome. In multivariate Cox models - including the study allocation arm and classical and non-classical risk factors - an increase of 20 walked metres during the 6MWT was associated to a 6% reduction of the risk for the composite end-point (P=0.001) and a similar relationship existed between the 6MWT, mortality (P<0.001) and hospitalizations (P=0.03). A similar trend was observed for cardiovascular events but this relationship did not reach statistical significance (P=0.09).
Conclusions: Poor physical performance predicts a high risk of mortality, cardiovascular events and hospitalizations in dialysis patients. Future studies, including phase-2 EXCITE, will assess whether improving motor fitness may translate into better clinical outcomes in this high risk population.
© 2014 S. Karger AG, Basel.
Source: PubMed