title: Factors affecting daily physical activity and physical performance in maintenance dialysis patients.
abstract: Maintenance hemodialysis (MHD) patients display reduced daily physical activity (DPA) and physical performance (PP). Previous studies did not differentiate the effects of kidney failure and MHD treatments from comorbidities as causes for reduced DPA and PP. In relatively healthy MHD patients and normal adults, we evaluated DPA and PP and examined relationships between DPA and PP and possible associations between anxiety or depression and DPA and PP. DPA, 6-minute walk distance (6-MWD), sit-to-stand (STS), and stair-climbing tests were measured in 72 MHD patients (40% diabetics) with limited comorbidities and 39 normal adults of similar age and gender mix. Anxiety and depression were measured by the Beck anxiety and depression inventories. DPA, time-averaged over 7 days, and all 3 PP tests were impaired in MHD patients, to about 60% to 70% of normal values (P < .0001 for each measurement). MHD patients spent more time sleeping or physically inactive (P < .0001) and less time in ≥ moderate activity (P < .0001). Adjusted DPA correlated with 6-MWD but not STS or stair-climbing. Anxiety and depression were identified in 43% and 33% of MHD patients and 2.5% and 5.1% of normals (P < .0001 for each comparison). Most of the impairment in DPA and PP tests were also observed in MHD patients without anxiety or depression. However, MHD patients with both anxiety and depression generally had the most impaired DPA and PP. In MHD patients, higher adjusted anxiety scores were correlated with impaired 6-MWD and STS, whereas adjusted average DPA was negatively correlated with depression (r = -0.33, P = .006) but not anxiety. DPA on the hemodialysis day (P = .01), day after dialysis (P = .03), and day 2 after dialysis (P = .03) each correlated negatively with degree of depression but not with anxiety. MHD patients displayed negative-adjusted correlations between anxiety and 6-MWD (P = .03) and STS (P = .04). In relatively healthy MHD patients, DPA and PP are substantially impaired and correlated with each other, even in patients without evidence for anxiety or depression. Anxiety and depression are common in MHD patients and are associated with further impairment in DPA and PP.
authors.affiliation: Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; David Geffen School of Medicine at UCLA, Los Angeles, California; UCLA Fielding School of Public Health, Los Angeles, California. Electronic address: jkopple@labiomed.org.
authors.forename: Joel D
authors.initials: JD
authors.lastname: Kopple
authors.affiliation: Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; Division of Nephrology, CHA Gumi Medical Center, CHA University, South Korea.
authors.forename: Jun C
authors.initials: JC
authors.lastname: Kim
authors.affiliation: Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.
authors.forename: Bryan B
authors.initials: BB
authors.lastname: Shapiro
authors.affiliation: Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; Division of Nephrology, Tianjin Union Medical Center, Tianjin, People's Republic of China.
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; Department of Nephrology, the First Affiliated Hospital of Xiamen University, People's Republic of China.
authors.forename: Yinan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Rehabilitation Clinical Trials Center, Division of Respiratory and Critical Care Physiology and Medicine Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.
authors.forename: Janos
authors.initials: J
authors.lastname: Porszasz
authors.affiliation: UCLA Clinical and Translational Science Institute, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Bross
authors.affiliation: Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; VA Boston Health Care System/Harvard South Shore Psychiatry Residency Program, Brockton, Massachusetts.
authors.forename: Usama
authors.initials: U
authors.lastname: Feroze
authors.affiliation: Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Upreti
authors.affiliation: UCLA Fielding School of Public Health, Los Angeles, California; Division of Nephrology and Hypertension, University of California at Irvine, Irvine, California; Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
mesh_terms: D001007:Anxiety / Q000150:complications / Q000523:psychology; D003863:Depression / Q000150:complications / Q000523:psychology; D015444:Exercise / Q000523:psychology*; D005080:Exercise Test / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D008297:Male; D010807:Physical Endurance; D006435:Renal Dialysis / Q000523:psychology*; D012890:Sleep; D013997:Time Factors