title: Physical performance and clinical outcomes in dialysis patients: a secondary analysis of the EXCITE trial.
abstract: OBJECTIVE
  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.
authors.affiliation: CNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Torino
authors.forename: Fabio
authors.initials: F
authors.lastname: Manfredini
authors.forename: Davide
authors.initials: D
authors.lastname: Bolignano
authors.forename: Filippo
authors.initials: F
authors.lastname: Aucella
authors.forename: Rossella
authors.initials: R
authors.lastname: Baggetta
authors.forename: Antonio
authors.initials: A
authors.lastname: Barillà
authors.forename: Yuri
authors.initials: Y
authors.lastname: Battaglia
authors.forename: Silvio
authors.initials: S
authors.lastname: Bertoli
authors.forename: Graziella
authors.initials: G
authors.lastname: Bonanno
authors.forename: Pietro
authors.initials: P
authors.lastname: Castellino
authors.forename: Daniele
authors.initials: D
authors.lastname: Ciurlino
authors.forename: Adamasco
authors.initials: A
authors.lastname: Cupisti
authors.forename: Graziella
authors.initials: G
authors.lastname: D'Arrigo
authors.forename: Luciano
authors.initials: L
authors.lastname: De Paola
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fabrizi
authors.forename: Pasquale
authors.initials: P
authors.lastname: Fatuzzo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Fuiano
authors.forename: Luigi
authors.initials: L
authors.lastname: Lombardi
authors.forename: Gaetano
authors.initials: G
authors.lastname: Lucisano
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Messa
authors.forename: Renato
authors.initials: R
authors.lastname: Rapanà
authors.forename: Francesco
authors.initials: F
authors.lastname: Rapisarda
authors.forename: Stefania
authors.initials: S
authors.lastname: Rastelli
authors.forename: Lisa
authors.initials: L
authors.lastname: Rocca-Rey
authors.forename: Chiara
authors.initials: C
authors.lastname: Summaria
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zuccalà
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tripepi
authors.forename: Luigi
authors.initials: L
authors.lastname: Catizone
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
authors.forename: Francesca
authors.initials: F
authors.lastname: Mallamaci
mesh_terms: D000368:Aged; D023381:Endpoint Determination; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D006435:Renal Dialysis; D016019:Survival Analysis; D016896:Treatment Outcome; D016138:Walking