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Intradialytic hypotension and objectively measured physical activity among patients on hemodialysis

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Abstract

Background

Intradialytic hypotension is related to patient-reported outcomes such as post-dialysis fatigue, but its impact on physical activity has not been fully studied. We aimed to examine the relationship between intradialytic blood pressure (BP) and objectively measured physical activity.

Methods

In this cross-sectional study, 192 hemodialysis patients underwent 4 weeks of physical activity measurement using triaxial accelerometers to measure step counts and moderate-to-vigorous physical activity (MVPA). Intradialytic BP parameters (pre-dialysis BP, post-dialysis BP, nadir BP, and fall in BP) were measured during all dialysis sessions. Mixed-effects linear regression models were used to analyze associations between intradialytic BP parameters and physical activity (1) after dialysis sessions on dialysis days and (2) on the following non-dialysis days.

Results

The mean age of the patients was 71 years, and 47% had diabetes mellitus. Valid physical activity data were obtained in a total of 1938 dialysis days and 2629 non dialysis days. Lower nadir diastolic BP was significantly associated with lower step counts and shorter moderate-to-vigorous physical activity not only on dialysis days but also on the following non-dialysis days. Nadir diastolic BP showed a higher discrimination capacity for physical inactivity, defined as a step count < 4000 on non-dialysis days, than the other BP parameters. The optimal cutoff point of nadir diastolic BP for discriminating physical inactivity was 68 mmHg; its sensitivity and specificity were 66% and 67%, respectively.

Conclusions

Lower nadir diastolic BP was strongly associated with lower physical activity on both dialysis and non-dialysis days. Nadir diastolic BP may be a predictor for physical inactivity.

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Availability of data and material

The data underlying this article cannot be shared publicly due to the privacy of individuals that participated in the study. The data will be shared on reasonable request to the corresponding author.

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Funding

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Author notes

  1. Koki Hattori and Yusuke Sakaguchi contributed equally to this work.

Authors and Affiliations

  1. Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan

    Koki Hattori, Sachio Kajimoto, Yuta Asahina, Yohei Doi, Tatsufumi Oka & Yoshitaka Isaka

  2. Department of Inter-Organ Communication Research in Kidney Diseases, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, 565-0871, Japan

    Yusuke Sakaguchi & Jun-Ya Kaimori

Authors
  1. Koki Hattori
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  2. Yusuke Sakaguchi
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Contributions

All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. KH and YS performed data analyses and wrote the manuscript. YS, SK, and JYK were responsible for the study design and data acquisition. YA, YD, TO, JYK, and YI contributed to data interpretation and manuscript revisions.

Corresponding author

Correspondence to Jun-Ya Kaimori.

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Ethical statement

The study protocol was approved by the ethics committee of the Osaka University Hospital (ID 19366). Study procedures were performed according to the principles of the Declaration of Helsinki.

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Informed consent was obtained from all participants.

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Hattori, K., Sakaguchi, Y., Kajimoto, S. et al. Intradialytic hypotension and objectively measured physical activity among patients on hemodialysis. J Nephrol 35, 1409–1418 (2022). https://doi.org/10.1007/s40620-021-01222-8

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  • DOI: https://doi.org/10.1007/s40620-021-01222-8

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