D JEGATHEESAN1,2, R MODDERMAN1, R KRISHNASAMY2,3, A TONG4,5, J COOMBES2, A VIECELLI1,2, D JOHNSON1,2, N ISBEL1,2
1Princess Alexandra Hospital, Woolloongabba, Australia, 2Centre for Kidney Disease Research, The University of Queensland, St Lucia, Australia, 3Sunshine Coast University Hospital, Birtinya, Australia, 4Sydney School of Public Health, The University of Sydney, Camperdown, Australia, 5Centre for Kidney Disease Research, The Children’s Hospital at Westmead, Westmead, Australia
Background & Aims: Impaired physical fitness is prevalent in people with chronic kidney disease (CKD), associating with an increased risk of mortality, falls and hospitalisation. A plethora of physical fitness outcomes have been reported in randomised trials. This study aimed to assess the scope and consistency of physical fitness outcomes and outcome measures reported in trials in CKD.
Methods: A systematic review of randomised trials reporting physical fitness outcomes in adults with CKD (not requiring kidney replacement therapy), receiving haemodialysis or peritoneal dialysis, and kidney transplant recipients was conducted. Studies were identified from MEDLINE, Embase and the Cochrane Library from 2000 to 2019. The scope, frequency and characteristics of outcome measures were categorised and analysed.
Results: From 112 trials and 6,047 participants, 87 tests/measurements were used to evaluate 30 outcomes measures that reported on 23 outcomes, categorised into five domains of physical fitness: neuromuscular fitness (reported in 76% of trials), exercise capacity (64%), physiological-metabolic (49%), body composition (36%) and cardiorespiratory fitness (30%). Neuromuscular fitness was examined by 37 tests/measurements including the physical function component of questionnaires (27%), 1-repetition maximum (9%) and hand-grip strength (9%). Outcome measures were assessed by lab-based (58% of all trials), field-based (31%) and patient-reported measures (11%), and commonly evaluated at 12 (30%), 26 (23%) and 52 weeks (10%).
Conclusions: There is large heterogeneity in the reporting of physical fitness outcomes, with inconsistencies particularly in the definitions of outcome measures. Standardisation in the assessment of physical fitness is required to improve the comparability of trial outcomes and enhance clinical recommendations.
Dr Dev Jegatheesan is a consultant nephrologist at the Princess Alexandra Hospital and PhD candidate with the University of Queensland. His research interests include physical fitness in kidney disease, patient-important outcomes, transplant infectious disease and glomerulonephritis. This research forms a part of his PhD titled ‘Patient-centred approaches to improve physical fitness in kidney disease’.