ESRD patients using permanent vascular access report greater physical activity compared with catheter users

• Type of Material: Article
• Authors: Haimanot Wasse, Emory University; Rebecca Zhang, Emory University; Kirsten L. Johansen, Emory University; Nancy Kutner, Emory University
• Language: English
• Date: 2013-02
• Publisher: Springer Verlag (Germany)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © Springer Science+Business Media, B.V. 2012
• Final Published Version (URL): http://link.springer.com/article/10.1007%2Fs11255-012-0137-9
• Title of Journal or Parent Work: International Urology and Nephrology
• ISSN: 0301-1623
• Volume: 45
• Issue: 1
• Start Page: 199
• End Page: 205
• Grant/Funding Information: This work was supported in part by a National Institutes of Health Career Development Award K23 DK65634 (Haimanot Wasse) and by National Institutes of Health contract HHSN267200715004C, ADB No. N01-DK-7-5004.
• Keywords: Dialysis vascular access; Physical function
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Purpose Low levels of physical activity among end-stage renal disease (ESRD) patients are associated with increased risk of hospitalization and mortality, and contributors to low activity levels are important to identify. Among hemodialysis (HD) patients, use of a central venous catheter (CVC) might impede physical activity due to factors such as infection or patient fear of catheter dislodgement. Methods This Comprehensive Dialysis Study surveyed patients who had recently started regular dialysis. Physical activity level was ascertained using responses to the Human Activity Profile (HAP) provided by 1,458 HD participants. We examined the association of vascular access type with patients’ scores on HAP subscales measuring self-care and leg effort, two dimensions that are especially important for daily living. Results 32.6% of patients used an arteriovenous fistula (AVF), 11.5% used an arteriovenous graft, 51.8% used a CVC, and 4.1% used a CVC with another maturing access. Patients’ self-care and leg effort scores differed by vascular access type and receipt of early nephrology care, and the mean self-care score of AVF users who received early care was similar to the mean score reported for healthy adults. Conclusions Reported levels of self-care and leg effort activity were higher among incident HD patients using an AVF compared to those using a CVC. Future research should examine whether reinforcing the importance of regular physical activity in the pre-dialysis period, as well as wider early use of AVF in the HD population, may improve physical activity levels among ESRD patients.