大阪大学腎臓内科学との共同研究の成果がAmerican Journal of Kidney Diseasesに掲載されました。
 
Title
Accelerometry-Derived Physical Activity Levels and Mortality in Hemodialysis Patients: A Prospective Cohort Study

Authors
Atsuko Hiraoka, Yusuke Sakaguchi, Hikaru Kadono, Takayuki Kawaoka, Tatsufumi Oka, Yohei Doi, Yuki Kawano, Hiro Kishimoto, Takafumi Saito, Ryohei Yamamoto, Isao Matsui, Masayuki Mizui, Jun-Ya Kaimori, Yoshitaka Isaka

受理日：2025年10月26日
掲載日：2025年12月08日
 [ PubMed ]

Abstract
Rationale & objective: Sedentary behavior is common among hemodialysis patients although large-scale data on physical activity (PA) objectively measured by accelerometers are scarce. We aimed to 1) compare PA levels between hemodialysis patients and community-dwelling adults, 2) estimate annual PA changes, and 3) determine associations between PA levels and mortality in hemodialysis patients.
Study design: Prospective cohort study.
Setting & participants: 1,030 Japanese hemodialysis patients were enrolled for PA measurements between June 2019 and July 2020, and followed for three years. PA data in community-dwelling adults were obtained from the Dazaifu-City Survey in Japan.
Exposure: Light-intensity PA, moderate-intensity PA, vigorous-intensity PA, and steps measured by triaxial accelerometers after enrollment and one year later, defined based on 10-second epoch-averaged metabolic equivalents (METs) of 1.6-2.9, 3.0-5.9, and ≥6.0, respectively.
Outcome: All-cause death.
Analytical approach: Cox proportional hazards models with least absolute shrinkage and selection operator (LASSO).
Results: The median (interquartile range) light-intensity PA, moderate-intensity PA, vigorous-intensity PA, and steps were 192 (128-263) min/day, 70 (26-169) min/week, 0 (0-0) min/week, and 1,832 (680-3,822)/day, respectively. Age- and sex-adjusted geometric means of light-intensity PA, moderate-to-vigorous intensity PA, and steps were 42%, 77%, and 73% lower among hemodialysis patients than community-dwelling adults. The least-squares mean annual changes in light-intensity PA, moderate-intensity PA, and steps were -12.4 min/day, -10.7 min/week, and -215 steps/day, respectively. The lowest hazard was observed at 216-262 min/day for light-intensity PA, 239-291 min/week for moderate-intensity PA, and 4,294-6,045/day for steps. LASSO identified light-intensity PA on non-dialysis days as the parameter most strongly associated with survival. The lowest mortality risk was observed at about 300 min/day of light-intensity PA on non-dialysis days, compared to about 200 min/day on dialysis days.
Limitation: Observational study design precludes causal inference.
Conclusion: Light-intensity PA on non-dialysis days, even for short durations, was associated with better survival in hemodialysis patients.

Keywords: accelerometer; hemodialysis; light-intensity physical activity; mortality; physical activity; prospective cohort study.