title: ESRD patients using permanent vascular access report greater physical activity compared with catheter users.
abstract: OBJECTIVE
  Low levels of physical activity among end-stage renal disease (ESRD) patients are associated with increased risk of hospitalization and mortality, and contributors to low activity levels are important to identify. Among hemodialysis (HD) patients, use of a central venous catheter (CVC) might impede physical activity due to factors such as infection or patient fear of catheter dislodgement.
  
  
  METHODS
  This Comprehensive Dialysis Study surveyed patients who had recently started regular dialysis. Physical activity level was ascertained using responses to the Human Activity Profile (HAP) provided by 1,458 HD participants. We examined the association of vascular access type with patients' scores on HAP subscales measuring self-care and leg effort, two dimensions that are especially important for daily living.
  
  
  RESULTS
  32.6% of patients used an arteriovenous fistula (AVF), 11.5% used an arteriovenous graft, 51.8% used a CVC, and 4.1% used a CVC with another maturing access. Patients' self-care and leg effort scores differed by vascular access type and receipt of early nephrology care, and the mean self-care score of AVF users who received early care was similar to the mean score reported for healthy adults.
  
  
  CONCLUSIONS
  Reported levels of self-care and leg effort activity were higher among incident HD patients using an AVF compared to those using a CVC. Future research should examine whether reinforcing the importance of regular physical activity in the pre-dialysis period, as well as wider early use of AVF in the HD population, may improve physical activity levels among ESRD patients.
authors.affiliation: Division of Nephrology, WMB, Emory University School of Medicine, Room 338, 1639 Pierce Dr., Atlanta, GA 30322, USA. hwasse@emory.edu
authors.forename: Haimanot
authors.initials: H
authors.lastname: Wasse
authors.forename: Rebecca
authors.initials: R
authors.lastname: Zhang
authors.forename: Kirsten L
authors.initials: KL
authors.lastname: Johansen
authors.forename: Nancy
authors.initials: N
authors.lastname: Kutner
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000367:Age Factors; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D062905:Central Venous Catheters; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D007866:Leg / Q000502:physiology; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009043:Motor Activity / Q000502:physiology*; D005082:Physical Exertion; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D012648:Self Care / Q000706:statistics & numerical data; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013997:Time Factors