Impact of physical activity on surrogate markers of cardiovascular disease in the haemodialysis population

Katherine L Hull; Lucy Abell; Sherna F Adenwalla; Roseanne E Billany; Stephanie Burns; James O Burton; Darren Churchward; Matthew P M Graham-Brown; Laura J Gray; Patrick Highton; Courtney J Lightfoot; Rahma Said; Alice C Smith; Hannah M L Young; Daniel S March

doi:10.1093/ckj/sfae198

Impact of physical activity on surrogate markers of cardiovascular disease in the haemodialysis population

Clin Kidney J. 2024 Jun 28;17(7):sfae198. doi: 10.1093/ckj/sfae198. eCollection 2024 Jul.

Authors

Katherine L Hull^{1

2}, Lucy Abell³, Sherna F Adenwalla^{1

2}, Roseanne E Billany¹, Stephanie Burns⁴, James O Burton^{1

2

5}, Darren Churchward¹, Matthew P M Graham-Brown^{1

2

5}, Laura J Gray^{3

6}, Patrick Highton⁷, Courtney J Lightfoot^{6

8}, Rahma Said³, Alice C Smith^{6

8}, Hannah M L Young^{4

6

7}, Daniel S March¹

Affiliations

¹ Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
² John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.
³ Department of Population Health Sciences, University of Leicester, Leicester, UK.
⁴ University Hospitals of Leicester NHS Trust, Leicester, UK.
⁵ School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
⁶ NIHR Biomedical Research Centre, Leicester, UK.
⁷ Diabetes Research Centre, Leicester General Hospital, University of Leicester, UK.
⁸ Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, UK.

Abstract

Background: The haemodialysis (HD) population is sedentary, with substantial cardiovascular disease risk. In the general population, small increases in daily step count associate with significant reductions in cardiovascular mortality. This study explores the relationship between daily step count and surrogate markers of cardiovascular disease, including left ventricular ejection fraction (LVEF) and native T1 (a marker of diffuse myocardial fibrosis), within the HD population.

Methods: This was a post hoc analysis of the association between daily step count and metabolic equivalent of task (MET) and prognostically important cardiac magnetic resonance imaging parameters from the CYCLE-HD study (ISRCTN11299707). Unadjusted linear regression and multiple linear regression adjusted for age, body mass index, dialysis vintage, haemoglobin, hypertension and ultrafiltration volume were performed. Significant relationships were explored with natural cubic spline models with four degrees of freedom (five knots).

Results: A total of 107 participants were included [age 56.3 ± 14.1 years, 79 (73.8%) males]. The median daily step count was 2558 (interquartile range 1054-4352). There were significant associations between steps and LVEF (β = 0.292; P = .009) and steps and native T1 (β = -0.245; P = .035). Further modelling demonstrated most of the increase in LVEF occurred at up to 2000 steps/day and there was an inverse dose-response relationship between steps and native T1, with the most pronounced reduction in native T1 between ≈2500 and 6000 steps/day.

Conclusions: The results suggest an association between daily step count and parameters of cardiovascular health in the HD population. These findings support the recommendations for encouraging physical activity but are not the justification. Further research should evaluate whether a simple physical activity intervention improves cardiovascular outcomes in individuals receiving maintenance HD.

Keywords: cardiac magnetic resonance imaging; cardiovascular disease risk; exercise; haemodialysis; physical activity.