American Journal of Kidney Diseases · Dec 8, 2025

Accelerometry-Derived Physical Activity Levels and Mortality in Hemodialysis Patients: A Prospective Cohort Study

By Hiraoka A, Sakaguchi Y, Kadono H et al.

RATIONALE & OBJECTIVE: Sedentary behavior is common among hemodialysis patients although large-scale data on physical activity (PA) objectively measured by accelerometers are scarce. We (1) compared PA levels between hemodialysis patients and community-dwelling adults, 2) estimated annual PA changes, and 3) determined associations between PA levels and mortality in hemodialysis patients. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: 1,030 Japanese hemodialysis patients enrolled for PA measurements between June 2019 and July 2020 and followed for 3 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 1 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 light-intensity PA, moderate-intensity PA, vigorous-intensity PA, and steps were 192 (IQR, 128-263) minutes/day, 70 (IQR, 26-169) minutes/week, 0 (IQR, 0-0) minutes/week, and 1,832 (IQR, 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 minutes/day, -10.7 minutes/week, and -215 steps/day, respectively. The lowest hazard was observed at 216-262 minutes/day for light-intensity PA, 239-291 minutes/week for moderate-intensity PA, and 4,294-6,045/day for steps. LASSO identified light-intensity PA on nondialysis days as the parameter most strongly associated with survival. The lowest mortality risk was observed at about 300 minutes/day of light-intensity PA on nondialysis days compared with about 200 minutes/day on dialysis days. LIMITATIONS: Observational study design precludes causal inference. CONCLUSIONS: Light-intensity PA on nondialysis days, even for short durations, was associated with better survival in hemodialysis patients. PLAIN-LANGUAGE SUMMARY: Sedentary behavior is prevalent in hemodialysis patients. Although current guidelines recommend 150-300 minutes/week of moderate-intensity physical activity (PA) (eg, brisk walking, cycling at a moderate pace, jogging) or 75-150 minutes/week of vigorous-intensity PA (eg, running, sprinting), it is uncertain whether these targets are applicable to hemodialysis patients who have a high prevalence of frailty. In this 3-year prospective cohort study involving 1,030 Japanese hemodialysis patients, light-intensity PA (eg, casual walking, light household activities, gardening, tai-chi) on nondialysis days was most closely associated with better survival among various PA parameters. The lowest mortality risk was observed at about 300 minutes/day of light-intensity PA on nondialysis days. Light-intensity PA, even for short durations, may be associated with favorable outcomes among hemodialysis patients.

doi.org/10.1053/j.ajkd.2025.10.011PubMed 41371386Populations