Pretransplant Physical Activity Predicts All-Cause Mortality in Kidney Transplant Recipients

Abstract Background Insufficient physical activity (PA) may increase the risk of all-cause mortality and cardiovascular disease (CVD) morbidity and mortality among kidney transplant recipients (KTRs), but limited research is available. We examine the relationship between PA and the development of CVD events, CVD death and all-cause mortality among KTRs. Methods A total of 3050 KTRs enrolled in an international homocysteine-lowering randomized controlled trial were examined (38% female; mean age 51.8 ± 9.4 years; 75% white; 20% with prevalent CVD). PA was measured at baseline using a modified Yale Physical Activity Survey, divided into tertiles (T1, T2 and T3) from lowest to highest PA. Kaplan–Meier survival curves were used to graph the risk of events; Cox proportional hazards regression models examined the association of baseline PA levels with CVD events (e.g. stroke, myocardial infarction), CVD mortality and all-cause mortality over time. Results Participants were followed up to 2500 days (mean 3.7 ± 1.6 years). The cohort experienced 426 CVD events and 357 deaths. Fully adjusted models revealed that, compared to the lowest tertile of PA, the highest tertile experienced a significantly lower risk of CVD events {hazard ratio [HR] 0.76 [95% confidence interval (CI) 0.59–0.98]}, CVD mortality [HR 0.58 (95% CI 0.35–0.96)] and all-cause mortality [HR 0.76 (95% CI 0.59–0.98)]. Results were similar in unadjusted models. Conclusions PA was associated with a reduced risk of CVD events and all-cause mortality among KTRs. These observed associations in a large, international sample, even when controlling for traditional CVD risk factors, indicate the potential importance of PA in reducing CVD and death among KTRs.

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Abstract MP35: Physical Activity and Risk of Cardiovascular Events and All-Cause Mortality Among Kidney Transplant Recipients

Circulation ◽

10.1161/circ.139.suppl_1.mp35 ◽

2019 ◽

Vol 139 (Suppl_1) ◽

Author(s):

Augustine Kang ◽

Hongseok Kim ◽

Carol E Garber ◽

Charles Eaton ◽

Patricia M Risica ◽

...

Keyword(s):

Physical Activity ◽

Kidney Transplant ◽

Cardiovascular Events ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

All Cause Mortality

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Abstract 16810: Myocardial Perfusion Abnormalities, Ejection Fraction, and Coronary Calcium Score Are Not Associated With All-Cause Mortality Among Potential Kidney Transplant Recipients at Emory University Hospital

Circulation ◽

10.1161/circ.142.suppl_3.16810 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Ryan S Cousins ◽

Billy Mullinax ◽

Lehman Godwin ◽

Adam J Mitchell

Keyword(s):

Multivariate Analysis ◽

Coronary Artery ◽

Kidney Transplant ◽

Stress Testing ◽

University Hospital ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Post Evaluation ◽

Emory University ◽

All Cause Mortality

Introduction: Screening for coronary artery disease in patients being considered for kidney transplant is common to stratify morbidity and mortality risk, but the optimal strategy, and its impact on outcomes, remains unclear. Here we test the hypothesis that myocardial perfusion imaging (MPI) abnormalities, left ventricular ejection fraction (LVEF), or coronary artery calcium (CAC) score are associated with all-cause mortality in potential kidney transplant recipients at Emory University Hospital (EUH). Methods: In a retrospective chart review, we assessed the relationship between patient demographics, single-photon emission MPI results, and CAC scoring with post-evaluation outcomes at 5 years in consecutive patients referred for pre-transplant stress testing at EUH in 2015. Mann-Whitney U and Chi-Square tests assessed between-group differences in continuous and categorical variables, respectively. Multivariate analysis was performed using logistic regression models. Results: During the study period, 589 patients (mean age 54 years; SEM 0.512, 58% male, 65% African American) underwent MPI and 424 also underwent CAC scoring. Overall, 90 patients (15%) had abnormal MPI (defined as any fixed or reversible defect) and 54 (9%) died during follow up. Age (mean 53.2 years; SEM 0.533 vs. 57.7 years; SEM 1.73, p=0.008), previous coronary artery bypass graft (CABG) (2.06% vs. 7.41%, p=0.017), and myocardial infarction (MI) post-evaluation (4.11% vs. 18.5%, p<0.001) were associated with all-cause mortality. Age (p=0.032) and MI post-evaluation (p<0.001) remained significant in multivariate analysis. MPI abnormalities, LVEF, and CAC score were not associated with all-cause mortality. Conclusions: Age and MI post-evaluation are associated with increased mortality in potential kidney transplant recipients referred for stress testing at EUH. We found no association between MPI abnormalities, LVEF, or CAC score and all-cause mortality.

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Effects of a Structured Physical Activity Program on Serum Adipokines and Markers of Inflammation and Volume Overload in Kidney Transplant Recipients

Annals of Transplantation ◽

10.12659/aot.917047 ◽

2019 ◽

Vol 24 ◽

pp. 569-575 ◽

Cited By ~ 3

Author(s):

Katarzyna Muras-Szwedziak ◽

Anna Masajtis-Zagajewska ◽

Ewa Pawłowicz ◽

Michał Nowicki

Keyword(s):

Physical Activity ◽

Kidney Transplant ◽

Volume Overload ◽

Physical Activity Program ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Markers Of Inflammation ◽

Activity Program

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Prevalence and Correlates of Accelerometer-Based Physical Activity and Sedentary Time Among Kidney Transplant Recipients

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358119882658 ◽

2019 ◽

Vol 6 ◽

pp. 205435811988265 ◽

Cited By ~ 1

Author(s):

Jeff K. Vallance ◽

Steven T. Johnson ◽

Stephanie Thompson ◽

Kevin Wen ◽

Ngan N. Lam ◽

...

Keyword(s):

Physical Activity ◽

Information System ◽

Kidney Transplant ◽

Sedentary Time ◽

Response Rate ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Cross Sectional ◽

System Database ◽

Northern Alberta

Background: Physical activity is recommended for kidney transplant recipents as it may improve outcomes including mortality, exercise capacity, muscle strength, and health-related quality of life. Objective: The objective of this study was to examine accelerometer-based physical activity and sedentary time profiles among kidney transplant recipients and examine possible demographic and clinical correlates of physical activity and sedentary time. Design: Cross-sectional. Setting: Edmonton, Alberta, Canada. Patients: Kidney transplant recipients were recruited (N = 1,284) from the Northern Alberta Renal Program’s Nephrology Information System database (1993-2016). Measurements: Participants wore an ActiGraph GT3X+ accelerometer on their hip during waking hours for seven consecutive days. Methods: Kidney transplant recipients (1993-2016) recruited from the Northern Alberta Renal Program’s Nephrology Information System database wore an accelerometer and completed a self-reported questionnaire. Multiple linear regression was used to determine associations between activity level, demographic, and clinical characteristics. Results: Participants’ (n = 133; 11% response rate) mean age (SD) was 58 (14) years and 56% were female. Mean total sedentary time was 9.4 (1.4) hours per day; total moderate-to-vigorous physical activity (MVPA) time was 20.7 (19.6) minutes per day. MVPA was significantly associated with age where each additional year was associated with 0.48 fewer min/day (ie, ~30 seconds) (unstandardized beta: B = −0.48 min/day, 95% confidence interval [95% CI]: −0.75, −0.22). Sedentary time was significantly associated with age ( B = 1.0 min/day, 95% CI: 0.03, 1.9), body mass index ( B = 2.7 min/day, 95% CI: 0.2, 5.13), education ( B = 39.1 min/day, 95% CI: 12.3, −65.8), and inversely associated with income ( B = −44.9 min/day, 95% CI: −73.1, −16.8). Limitations: Limitations include the cross-sectional design, poor response rate, and limited generalizability of the results. Conclusions: Kidney transplant recipients showed high volumes of sedentary time and low volumes of health-enhancing physical activity. Understanding correlates of these behaviors may aid in the development of interventions to favorably change these behaviors.

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Osmoregulation Performance and Kidney Transplant Outcome

Journal of the American Society of Nephrology ◽

10.1681/asn.2018121269 ◽

2019 ◽

Vol 30 (7) ◽

pp. 1282-1293 ◽

Cited By ~ 1

Author(s):

Manal Mazloum ◽

Jordan Jouffroy ◽

François Brazier ◽

Christophe Legendre ◽

Antoine Neuraz ◽

...

Keyword(s):

Kidney Transplant ◽

Renal Outcome ◽

Plasma Sodium ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Loading Test ◽

Water Loading ◽

All Cause Mortality ◽

Allograft Loss ◽

Transplantation Outcomes

BackgroundKidney transplant recipients have an impaired ability to dilute urine but seldom develop baseline hyponatremia before ESRD. Although hyponatremia is a risk factor for adverse events in CKD and in kidney transplant recipients, it remains unclear whether subtler alterations in osmoregulation performance are associated with outcome.MethodsWe studied a single-center prospective cohort of 1258 kidney transplant recipients who underwent a water-loading test 3 months after transplant to determine osmoregulation performance. Measured GFR (mGFR) was performed at the same visit. A group of 164 healthy candidates for kidney donation served as controls. We further evaluated the association of osmoregulation performance with transplantation outcomes and subsequent kidney function.ResultsUnlike controls, most kidney transplant recipients failed to maintain plasma sodium during water loading (plasma sodium slope of −0.6±0.4 mmol/L per hour in transplant recipients versus −0.12±0.3 mmol/L per hour in controls; P<0.001). Steeper plasma sodium reduction during the test independently associated with the composite outcome of all-cause mortality and allograft loss (hazard ratio [HR], 1.73 per 1 mmol/L per hour decrease in plasma sodium; 95% confidence interval [95% CI], 1.23 to 2.45; P=0.002) and allograft loss alone (HR, 2.04 per 1 mmol/L per hour decrease in plasma sodium; 95% CI, 1.19 to 3.51; P=0.01). The association remained significant in a prespecified sensitivity analysis excluding patients with hyperglycemia. In addition, a steeper plasma sodium slope 3 months after transplantation independently correlated with lower mGFR at 12 months (β=1.93; 95% CI, 0.46 to 3.41; P=0.01).ConclusionsReduced osmoregulation performance occurs frequently in kidney transplant recipients and is an independent predictor of renal outcome.

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