The Association between Leisure-Time Physical Activity Intensity and Duration with the Risk of Mortality in Patients with Chronic Kidney Disease with or without Cardiovascular Diseases

Ning Li¹, Ruoyang Hong¹, Weiguo Zhou¹, Jingchen Zhong¹, Mingyun Kan¹, Yawei Zheng¹, Enchao Zhou^1,*, Wei Sun¹, Lu Zhang^1,*

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¹ Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, 210029 Nanjing, Jiangsu, China

^*Correspondence: zhanglu@njucm.edu.cn (Lu Zhang); enchaoz11@163.com (Enchao Zhou)
Academic Editors: Giuseppe Coppolino and Davide Bolignano

Rev. Cardiovasc. Med. 2022, 23(7), 244; https://doi.org/10.31083/j.rcm2307244

Submitted: 29 March 2022 | Revised: 22 May 2022 | Accepted: 9 June 2022 | Published: 28 June 2022

(This article belongs to the Special Issue Holistic Vision of Cardiovascular Complications in Chronic Kidney Disease)

This is an open access article under the CC BY 4.0 license.

Abstract

Introduction: For chronic kidney disease (CKD) patients with or without cardiovascular diseases, the associations between leisure-time physical activity intensity (LTPA) and daily exercise time with mortality risk remain unclear. Method: This study enrolled 3279 CKD patients from National Health and Nutrition Examination Survey (NHANES) 2007–2014 survey. Patients were grouped into different groups according to LTPA intensity (none, moderate, vigorous) and duration (0 min, 0–30 min, 30–60 min, $>$ 60 min). We selected the confounders based on their connections with the outcomes of interest or a change in effect estimate of more than 10%. Multivariable-adjusted Cox proportional hazards models were used to examine the associations between LTPA and mortality. The three-knot cubic spline (10, 50, and 90%) was employed to investigate the relationship between the dose of LTPA duration and all-cause death. Patients were divided into different groups according to cardiovascular diseases (CVD). Results: A total of 564 all-cause death were recorded in this study. Multivariable Cox regression showed that moderate LTPA was associated with a reduced risk of mortality by 38% (hazard ratio (HR): 0.62, 95% confidence interval (CI): 0.44–0.88) in CKD patients, while vigorous LTPA did not have evident survival benefits (HR: 0.91, 95% CI: 0.46–2.64). Subgroups analysis demonstrated that those who engaged in moderate LTPA have a significantly lower risk of mortality (HR: 0.67, 95% CI: 0.47–0.95) in patients without CVD, while patients complicated with CVD did not benefit from the practice (HR: 0.61, 95% CI: 0.37–1.02). Physical exercise for more than 30 minutes was associated with a lower risk of mortality in general CKD patients (30–60 min: HR: 0.23, 95% CI: 0.09–0.58, $>$ 60 min: HR: 0.23, 95% CI: 0.08–0.63) and those without CVD (30–60 min/d: HR: 0.32, 95% CI: 0.12–0.83, $>$ 60 min/d: HR: 0.20, 95% CI: 0.06–0.71); however, this positive outcome was not seen in patients complicated with CVD (30–60 min/d: HR: 0.67, 95% CI: 0.11–4.04, $>$ 60 min/d: HR: 1.14, 95% CI: 0.14–9.11). Conclusions: Moderate LTPA for more than 30 minutes is associated with a reduced risk of mortality in general CKD patients and those without CVD. However, LTPA did not reduce the risk of mortality in CKD patients complicated with CVD.