Most US Dialysis Patients Participate in Regular Exercise

By Peter Laird, MD

Exercise is one of the most important methods of improving outcomes in both the general population as well as in the dialysis population. Despite the claims that American dialysis patients are less healthy and more inactive than their Japanese, European and Australian counterparts, a recent study by DOPPS points out an excellent exercise participation by the majority of American dialysis patients:

Physical Exercise among Participants in the Dialysis Outcomes and Practice Patterns Study (DOPPS): Predictors and Associated Outcomes.

RESULTS: Regular exercise frequency varied widely across countries and across dialysis facilities within a country. Overall, 47.4% of participants were categorized as regular exercisers. The odds of regular exercise was 38% higher for patients from facilities offering exercise programmes (adjusted odds ratio = 1.38 [95% confidence interval: 1.03-1.84]; P = 0.03). Regular exercisers had higher HRQoL, physical functioning and sleep quality scores; reported fewer limitations in physical activities; and were less bothered by bodily pain or lack of appetite.

Despite this excellent survey of American dialysis patients compared to their cohorts in other nations, exercise alone does not mitigate the other factors that attribute to our last place mortality compared to other nations:

Why Is the Mortality of Dialysis Patients in the United States Much Higher than the Rest of the World?

Studies reported by DOPPS consistently show a marked difference in crude mortality between different countries, with the mortality in the United States being one of the highest. For example, in 2003, DOPPS reported the crude 1-yr mortality rates were 6.6% in Japan, 15.6% in Europe, and 21.7% in the United States. After adjustment for age, gender, race, and 25 comorbid conditions, including cardiovascular comorbidity, the relative risk (RR) for mortality was 2.84 for Europe compared with Japan and 3.78 for the United States compared with Japan. Thus, variability in demographic and comorbid conditions at dialysis inception explains only part of the variances in mortality between countries.

The recent study by DOPPS of the exercise habits among patients in different nations would not suggest a more sedentary population in the United States which is often one of the excuses many nephrologists juxtapose for these poor mortality outcomes. This study, while encouraging in the fact that most American dialysis patients do participate in frequent exercise, begs the question asked in the second article, why is the mortality of dialysis patients in the United States higher than the rest of the world?

Comments

[B.S.]

Hi (Most US Dialysis Patients Participate in Regular Exercise)(Overall, 47.4% of participants were categorized as regular exercisers.)
When does 47.4% equals MOST? Its not even Half.
I work in a major dialysis company and oversee several dialysis clinics in a large urban city. I dont need a study to just look at all the patients in this area and I can through out a % to. MOST 90% of patients in this area Dont exercise. I am not sure where this survey is from or area it was done, but the patients did not tell the truth.

[Peter Laird, MD]

Sir, I would suggest that you go back and read through the abstract more closely. 47.4% of all patients in this international study participated in exercise. That was the entire study cohort from several nations. If you download the PowerPoint Slides that accompany the abstract, you will see the breakdown of exercise and frequency by individual nations in the study. Italy has a much better overall mortality rate than the US, but very low exercise participation.

The US has very high mortality but according to this well done DOPPS survey, it ranks high among the nations that have patients that exercise and are on dialysis. The total amount is about 55% of US patients.

I am sorry to hear that 90% of your patients do not exercise. Perhaps your dialysis unit should consider the fact that places your unit in one of the lowest percentiles for exercise and begin to address what sounds like a major problem that should be corrected. Instead, it sounds as if you blaming the patients themselves. If you read through the DOPPS report, they noted that dialysis units that offered patients exercise programs outside of the unit or during dialysis had a much higher percentage of patients that did exercise. You may wish to review the entire study and discuss this with your team to see how you can improve such a low level of participation in exercise.

[Bill Peckham]

I presented this DOPPS data at KidneyWeek, it also showed that if a unit had an exercise program dialyzors were significantly more likely to exercise. The unfortunate unit where BS works could improve people's lives by doing a better job.