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作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

　　October 19, 2009 — 根據發表於10月9日線上第一版美國腎臟學會臨床期刊(Clinical Journal of the American Society of Nephrology)的一篇觀察研究結果，缺乏運動和慢性腎臟病(CKD)患者死亡率增加有關。
　　
　　猶他大學與鹽湖城VA健康照護體系的Srinivasan Beddhu醫師等人寫道，CKD與體能活力不佳有關。不過，還不清楚是否因出現CKD而改變體能活力與死亡率之間的關聯；因此，我們檢視CKD和體能活力與死亡率之間的影響。
　　
　　研究世代包括「National Health and Nutrition Examination Survey III」這項研究中的15,368名成人，其中5.9%有CKD，定義是估計腎絲球過濾速率小於60 mL/分/1.73 m2。根據有關休閒時間體能活動的頻率與密度問卷，將這些病患分類成無活動力、活動力不足、有活動力這幾組，使用Cox模式來確認到發生死亡的時間，平均追蹤期間為7到9年。
　　
　　非CKD研究對象中，13.5%為無活動力組，CKD病患中則有28.0%(P < .001)。分別進行Cox模式分析發現，非CKD研究對象中，相較於無活動力組，活動力不佳組以及有活動力組的死亡率勝算比(HRs)分別是0.60(95%信心區間[CI]為0.45 - 0.81)以及0.59(95% CI為0.45 - 0.77)；CKD 病患中，相較於無活動力組，活動力不佳組以及有活動力組的死亡率勝算比分別是0.58 (95% CI，0.42 - 0.79)以及0.44 (95% CI，0.33 - 0.58)。這些HRs值在非CKD之研究對象和CKD病患之間沒有統計上的顯著差異(P > .3)。
　　
　　研究限制包括，使用現有資料的觀察型設計，可能有沒發現的其他干擾因素，以及體能活力採自我報告。
　　
　　研究作者寫道，體能活力與CKD病患和非CKD研究對象的死亡率增加有關。不論是CKD 病患和非CKD研究對象，增加體能活力可能有存活利益。這對那些第3期CKD病患來說特別重要，因為許多病患在還沒變成末期腎臟病之前就死亡了。
　　
　　猶他州透析研究基金會支持本研究。研究作者們皆宣告沒有相關財務關係。
　　
　　Clin J Am Soc Nephrol.線上發表於2009年10月9日。

Lack of Exercise Linked to Increased Mortality in Chronic Kidney Disease

By Laurie Barclay, MD
Medscape Medical News

October 19, 2009 — Lack of exercise is linked to increased mortality rates in chronic kidney disease (CKD), according to the results of an observational study reported in the October 9 Online First issue of the Clinical Journal of the American Society of Nephrology.

"...CKD is associated with impaired physical activity," write Srinivasan Beddhu, MD, from Salt Lake City VA Healthcare System and University of Utah, and colleagues. "However, it is unclear whether the associations of physical activity with mortality are modified by the presence of CKD. Therefore, we examined the effects of CKD on the associations of physical activity with mortality."

The study cohort consisted of 15,368 adults enrolled in the National Health and Nutrition Examination Survey III, of whom 5.9% had CKD, defined as an estimated glomerular filtration rate of less than 60 mL/minute/1.73 m2. A questionnaire regarding frequency and intensity of leisure time physical activity allowed categorizing the participants into inactive, insufficiently active, and active groups. Cox models were used to determine time to mortality. Average duration of follow-up was 7 to 9 years.

Of the non-CKD participants, 13.5% were inactive vs 28.0% of the CKD groups (P < .001). Compared with the physically inactive group, the insufficiently active and active groups had hazard ratios (HRs) of mortality of 0.60 (95% confidence interval [CI], 0.45 - 0.81) and 0.59 (95% CI, 0.45 - 0.77) in the non-CKD subpopulation and 0.58 (95% CI, 0.42 - 0.79) and 0.44 (95% CI, 0.33 - 0.58) in the CKD subpopulation, respectively, in 2 separate multivariable Cox models. These HRs were not statistically significantly different between the CKD and non-CKD subpopulations (P > .3).

Limitations of this study include observational design using existing data, possible unmeasured residual confounding, and self-reported physical activities.

"Physical inactivity is associated with increased mortality in CKD and non-CKD populations," the study authors write. "As in the non-CKD population, increased physical activity might have a survival benefit in the CKD population....This is particularly important as most patients with stage III CKD die before they develop end stage renal disease."

The Dialysis Research Foundation of Utah supported this study. The study authors have disclosed no relevant financial relationships.

Clin J Am Soc Nephrol. Published online October 9, 2009.