title: Lower C-reactive protein and better hemodialysis survival are associated with regular exercise activity: Longitudinal outcomes from the ACTIVE-ADIPOSE special study.
abstract: Introduction Cross-sectional and longitudinal studies in the general population have shown that a physically active lifestyle may have anti-inflammatory properties, but evidence from studies conducted with maintenance hemodialysis (HD) patients is limited. Methods A multicenter prospective cohort of 755 HD participants aged 20-92 was evaluated in a USRDS special study 2009-2013. Kilocalories/week (kcal/week) of leisure time physical activity (LTPA) was estimated from the Minnesota Leisure Time Activity questionnaire. Predialysis serum samples were obtained concurrent with LTPA report date. Generalized estimating equations (GEE) examined association of participants' LTPA and log-normalized CRP across 24 months. Cox proportional hazards models investigated LTPA and survival over a median follow-up of 718 days. Findings Baseline median CRP concentration was lower for participants with 500+ kcal/week LTPA vs. those with <500 kcal/week LTPA (3.4 mg/L vs. 4.6 mg/L; P = 0.03). Participants who reported lower LTPA (<500 kcal/week) at both baseline and 12 months had a borderline significant increase in CRP concentration (within-group change 4.8 [1.9-10.4] to 5.8 [1.6-15.7]; P = 0.08). Lower LTPA was associated with higher log CRP over 24 months in adjusted GEE analyses (β coefficient = 0.16 [95% CI 0.02-0.31]; P = 0.03). 67/364 (18%) and 43/391 (11%) deaths occurred, respectively, among participants reporting <500 vs. 500+ kcal/week LTPA [adjusted mortality hazard ratio 1.63 (CI, 1.07, 2.47)]. Discussion The data suggest that increased estimated levels of LTPA, a physical activity/exercise opportunity widely applicable to HD patients, may be associated with lower CRP concentration as well as better survival outcome.
authors.affiliation: Department of Rehabilitation Medicine, School of Medicine, Atlanta, Georgia, USA.
authors.forename: Nancy G
authors.initials: NG
authors.lastname: Kutner
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors.forename: Yijian
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Medicine and Department of Biochemistry and Molecular Medicine, University of California, Davis, California, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Kaysen
authors.affiliation: Renal Division, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA.
authors.forename: Jeanie
authors.initials: J
authors.lastname: Park
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism*; D003430:Cross-Sectional Studies; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods* / Q000401:mortality; D011795:Surveys and Questionnaires; D016019:Survival Analysis
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; USRDS; activity; hemodialysis