Claudia Torino1, Fabio Manfredini2, Davide Bolignano1, Filippo Aucella3, Rossella Baggetta1, Antonio Barillà4, Yuri Battaglia4, Silvio Bertoli5, Graziella Bonanno6, Pietro Castellino7, Daniele Ciurlino5, Adamasco Cupisti8, Graziella D’Arrigo1, Luciano de Paola9, Fabrizio Fabrizi10, Pasquale Fatuzzo6, Giorgio Fuíano11, Luigi Lombardi9, Gaetano Lucisano11, Piergiorgio Messa10, Renato Rapanà12, Francesco Rapisarda6, Stefania Rastelli7, Lisa Rocca-Rey5, Chiara Summaria11, A Zuccalà12, Giovanni Tripepi1, Luigi Catizone4, Carmine Zoccali1, Francesca Mallamaci1
1CNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, Italy
2Department of Biomedical Sciences and Surgical Specialties -Section of Sport Sciences, University of Ferrara
3Nephrology Unit, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia)
4Nephrology Unit, AOU Ferrara Arcispedale S. Anna, Ferrara
5Nephrology and Dialysis Unit, IRCCS Multimedica - Policlinico Multispecialistico, Sesto S. Giovanni, Milan
6Clinical Division of Chirurgical Nephrology, University of Catania - Azzurra Medical Nephrological Ambulatory and Dialysis Techniques, Catania
7Department of Internal Medicine, University of Catania
8Department of Clinical and Experimental Medicine, University of Pisa
9Nephrology and Dialysis Unit, Ospedale Pugliese-Ciaccio, Catanzaro
10Nefrology and Dialysis Unit, IRCCS Cà Granda Ospedale Maggiore - Policlinico, Milano
11Nephrology and Dialysis Unit, Policlinico Universitario Mater Domini, Catanzaro, Italy
12Nephrology and Dialysis Unit, Ospedale Civile, Imola
Tóm tắt
<b><i>Background/Aims: </i></b>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. <b><i>Methods: </i></b>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). <b><i>Results: </i></b>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). <b><i>Conclusions: </i></b>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.
