Prognostic value of the six-minute walk test in end-stage renal disease life expectancy: a prospective cohort study

Leandro de Moraes Kohl, Luis Ulisses Signori, Rodrigo Antonini Ribeiro, Antonio Marcos Vargas Silva, Paulo Ricardo Moreira, Thiago Dipp, Graciele Sbruzzi, Janice Luisa Lukrafka, Rodrigo Della Méa Plentz, Leandro de Moraes Kohl, Luis Ulisses Signori, Rodrigo Antonini Ribeiro, Antonio Marcos Vargas Silva, Paulo Ricardo Moreira, Thiago Dipp, Graciele Sbruzzi, Janice Luisa Lukrafka, Rodrigo Della Méa Plentz

Abstract

Objectives: The six-minute walk test has been widely used to evaluate functional capacity and predict mortality in several populations. Thus, the aim of this study was to evaluate the prognostic value of the six-minute walk test for the life expectancy of end-stage renal disease patients.

Methods: Patients over 18 years old who underwent hemodialysis for at least six months were included. Patients with hemodynamic instability, smoking, chronic obstructive pulmonary disease, physical incapacity and acute myocardial stroke in the preceding three months were excluded.

Results: Fifty-two patients (54% males; 36+11 years old) were followed for 144 months. The distance walked in the six-minute walk test was a survival predictor for end-stage renal disease patients. In the multivariate analysis, for each 100 meters walked with a 100-meter increment, the hazard ratio was 0.53, with a 95% confidence interval of 0.37-0.74. There was a positive correlation between the distance walked in the six-minute walk test and peak oxygen consumption (r = 0.508). In the multivariate analysis, each year of dialysis treatment represented a 10% increase in death probability; in the severity index analysis, each point on the scale represented an 11% increase in the death risk.

Conclusions: We observed that survival increased approximately 5% for every 100 meters walked in the six-minute walk test, demonstrating that the test is a viable option for evaluating the functional capacity in patients with end-stage renal disease.

Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
Flowchart of the patients allocated in the study.
Figure 2
Figure 2
Correlation between the six-minute walk test and peak oxygen consumption.

References

    1. Brosnahan G, Fraer M. Chronic kidney disease: whom to screen and how to treat, part 1: definition, epidemiology, and laboratory testing. South Med J. 2010;103(2):140–6.
    1. Riley M, McParland J, Stanford CF, Nicholls DP. Oxygen consumption during corridor walk testing in chronic cardiac failure. Eur Heart J. 1992;13(6):789–93.
    1. Sietsema KE, Amato A, Adler SG, Brass EP. Exercise capacity as a predictor of survival among ambulatory patients with end-stage renal disease. Kidney Int. 2004;65(2):719–24.
    1. McIntyre CW, Selby NM, Sigrist M, Pearce LE, Mercer TH, Naish PF. Patients receiving maintenance dialysis have more severe functionally significant skeletal muscle wasting than patients with dialysis-independent chronic kidney disease. Nephrol Dial Transplant. 2006;21(8):2210–6.
    1. NSW. NSW clinical service framework for heart failure. Available from: .
    1. Rubim VS, Drumond Neto C, Romeo JL, Montera MW. [Prognostic value of the Six-Minute Walk Test in heart failure] Arq Bras Cardiol. 2006;86(2):120–5.
    1. Guimaraes GV, Carvalho VO, Bocchi EA. Reproducibility of the self-controlled six-minute walking test in heart failure patients. Clinics. 2008;63(2):201–6.
    1. Guimaraes GV, D'Avila V, Bocchi EA, Carvalho VO. Norepinephrine remains increased in the six-minute walking test after heart transplantation. Clinics. 2010;65(6):587–91.
    1. Regueiro EM, Di Lorenzo VA, Basso RP, Pessoa BV, Jamami M, Costa D. Relationship of BODE Index to functional tests in chronic obstructive pulmonary disease. Clinics. 2009;64(10):983–8.
    1. Miyamoto S, Nagaya N, Satoh T, Kyotani S, Sakamaki F, Fujita M, et al. Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2000;161(2 Pt 1):487–92.
    1. Painter P. Physical functioning in end-stage renal disease patients: update 2005. Hemodial Int. 2005;9(3):218–35.
    1. Du H, Newton PJ, Salamonson Y, Carrieri-Kohlman VL, Davidson PM. A review of the six-minute walk test: its implication as a self-administered assessment tool. Eur J Cardiovasc Nurs. 2009;8(1):2–8.
    1. Savci S, Inal-Ince D, Arikan H, Guclu-Gunduz A, Cetisli-Korkmaz N, Armutlu K, et al. Six-minute walk distance as a measure of functional exercise capacity in multiple sclerosis. Disabil Rehabil. 2005 30;27(22):1365–71.
    1. Bittner V, Weiner DH, Yusuf S, Rogers WJ, McIntyre KM, Bangdiwala SI, et al. Prediction of mortality and morbidity with a 6-minute walk test in patients with left ventricular dysfunction. SOLVD Investigators. JAMA. 1993;270(14):1702–7.
    1. Gayda M, Temfemo A, Choquet D, Ahmaidi S. Cardiorespiratory requirements and reproducibility of the six-minute walk test in elderly patients with coronary artery disease. Arch Phys Med Rehabil. 2004;85(9):1538–43.
    1. Lipkin DP, Scriven AJ, Crake T, Poole-Wilson PA. Six minute walking test for assessing exercise capacity in chronic heart failure. Br Med J (Clin Res Ed) 1986;292(6521):653–5.
    1. Olsson LG, Swedberg K, Clark AL, Witte KK, Cleland JG. Six minute corridor walk test as an outcome measure for the assessment of treatment in randomized, blinded intervention trials of chronic heart failure: a systematic review. Eur Heart J. 2005;26(8):778–93.
    1. Hsieh RL, Lee WC, Chang CH. Maximal cardiovascular fitness and its correlates in ambulatory hemodialysis patients. Am J Kidney Dis. 2006;48(1):21–7.
    1. Pina IL, Balady GJ, Hanson P, Labovitz AJ, Madonna DW, Myers J. Guidelines for clinical exercise testing laboratories. A statement for healthcare professionals from the Committee on Exercise and Cardiac Rehabilitation, American Heart Association. Circulation. 1995;91(3):912–21.
    1. [National Consensus on Ergometry. Department of Ergometry and Cardiovascular Rehabilitation of the Brazilian Cardiology Society] Arq Bras Cardiol. 1995;65(2):189–211.
    1. Bruce RA. Evaluation of functional capacity and exercise tolerance of cardiac patients. Mod Concepts Cardiovasc Dis. 1956;25(4):321–6.
    1. Ross DL, Grabeau GM, Smith S, Seymour M, Knierim N, Pitetti KH. Efficacy of exercise for end-stage renal disease patients immediately following high-efficiency hemodialysis: a pilot study. Am J Nephrol. 1989;9(5):376–83.
    1. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–81.
    1. Craven J, Littlefield C, Rodin G, Murray M. The Endstage Renal Disease Severity Index (ESRD-SI) Psychol Med. 1991;21(1):237–43.
    1. Green J, Wintfeld N, Sharkey P, Passman LJ. The importance of severity of illness in assessing hospital mortality. JAMA. 1990;263(2):241–6.
    1. Painter P, Moore G, Carlson L, Paul S, Myll J, Phillips W, et al. Effects of exercise training plus normalization of hematocrit on exercise capacity and health-related quality of life. Am J Kidney Dis. 2002;39(2):257–65.
    1. Kong CH, Tattersall JE, Greenwood RN, Farrington K. The effect of exercise during haemodialysis on solute removal. Nephrol Dial Transplant. 1999;14(12):2927–31.
    1. Arslan S, Erol MK, Gundogdu F, Sevimli S, Aksakal E, Senocak H, et al. Prognostic value of 6-minute walk test in stable outpatients with heart failure. Tex Heart Inst J. 2007;34(2):166–9.
    1. Pulz C, Diniz RV, Alves AN, Tebexreni AS, Carvalho AC, de Paola AA, et al. Incremental shuttle and six-minute walking tests in the assessment of functional capacity in chronic heart failure. Can J Cardiol. 2008;24(2):131–5.
    1. Painter P, Messer-Rehak D, Hanson P, Zimmerman SW, Glass NR. Exercise capacity in hemodialysis, CAPD, and renal transplant patients. Nephron. 1986;42(1):47–51.
    1. McGavin CR, Gupta SP, McHardy GJ. Twelve-minute walking test for assessing disability in chronic bronchitis. Br Med J. 1976;1(6013):822–3.
    1. Parsons TL, Toffelmire EB, King-VanVlack CE. The effect of an exercise program during hemodialysis on dialysis efficacy, blood pressure and quality of life in end-stage renal disease (ESRD) patients. Clin Nephrol. 2004;61(4):261–74.
    1. Parfrey P. Anaemia in chronic renal disease: lessons learned since Seville 1994. Nephrol Dial Transplant. 2001;16(Suppl 7):41–5.
    1. Guyatt GH, Sullivan MJ, Thompson PJ, Fallen EL, Pugsley SO, Taylor DW, et al. The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J. 1985;132(8):919–23.
    1. Moreira PR, Plentz R, Aguirre M, Barros E. Avaliação da capacidade aeróbia de pacientes em hemodiálise. Rev Bras Med Esport. 1997;3(1):1–5.
    1. Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE. The impact of anemia on cardiomyopathy, morbidity, and and mortality in end-stage renal disease. Am J Kidney Dis. 1996;28(1):53–61.
    1. Levin A, Thompson CR, Ethier J, Carlisle EJ, Tobe S, Mendelssohn D, et al. Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin. Am J Kidney Dis. 1999;34(1):125–34.
    1. Abensur H. Anemia da doença renal crônica. Diretrizes Brasileiras de Doença Renal Crônica. J Bras Nefrol. 2004;26(Supl 1):26–8.
    1. Rostagno C, Olivo G, Comeglio M, Boddi V, Banchelli M, Galanti G, et al. Prognostic value of 6-minute walk corridor test in patients with mild to moderate heart failure: comparison with other methods of functional evaluation. Eur J Heart Fail. 2003;5(3):247–52.
    1. Jehn M, Schmidt-Trucksaess A, Schuster T, Hanssen H, Weis M, Halle M, et al. Accelerometer-based quantification of 6-minute walk test performance in patients with chronic heart failure: applicability in telemedicine. J Card Fail. 2009;15(4):334–40.
    1. Mercer TH, Naish PF, Gleeson NP, Wilcock JE, Crawford C. Development of a walking test for the assessment of functional capacity in non-anaemic maintenance dialysis patients. Nephrol Dial Transplant. 1998;13(8):2023–6.

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