title: Pretransplant physical activity predicts all-cause mortality in kidney transplant recipients.
abstract: BACKGROUND
  Low physical activity (PA) has been associated with higher rates of cardiovascular disease (CVD) and mortality in the general population. Despite the benefits of kidney transplantation, kidney transplant recipients (KTRs) remain at elevated risk for CVD and mortality compared to individuals without kidney disease.
  
  
  METHODS
  A prospective cohort of 507 adult KTRs from three academic centers completed the Physical Activity Scale for the Elderly (PASE) at transplantation. PASE scores were divided into tertiles.
  
  
  RESULTS
  PA was lower with older age, history of CVD, smoking, and diabetes. During the median 8-year follow-up period, 128 individuals died, among whom 101 had a functioning allograft. In multivariable Cox regression for all-cause mortality, greater PA was strongly associated with better survival (HR: 0.52 for most active vs. inactive tertiles, 95% CI: 0.31-0.87, p = 0.01). Secondary analyses, in which (1) death with a functioning graft was the primary outcome, and (2) PASE scores were converted to the metabolic equivalent of task, revealed similar results. We did not find an association between change of PA after transplantation and mortality.
  
  
  CONCLUSIONS
  PA at the time of kidney transplantation is a strong predictor of all-cause mortality and death with graft function. Evaluation of PA level among kidney transplant candidates may be a useful method to risk-stratify patients for survival after kidney transplantation. Kidney transplant candidates and recipients should also be encouraged to be physically active.
authors.affiliation: Philadelphia Veterans Administration Medical Center, University of Pennsylvania, Philadelphia, USA. Sylvia.Rosas@uphs.upenn.edu
authors.forename: Sylvia E
authors.initials: SE
authors.lastname: Rosas
authors.forename: Peter P
authors.initials: PP
authors.lastname: Reese
authors.forename: Yonghong
authors.initials: Y
authors.lastname: Huan
authors.forename: Cataldo
authors.initials: C
authors.lastname: Doria
authors.forename: Philip T
authors.initials: PT
authors.lastname: Cochetti
authors.forename: Alden
authors.initials: A
authors.lastname: Doyle
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D012306:Risk; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome