医学
危险系数
置信区间
观察研究
比例危险模型
透析
随机对照试验
内科学
物理疗法
相对风险
低风险
作者
Francesca Mallamaci,Graziella D’Arrigo,Giovanni Tripepi,Nicola Lamberti,Claudia Torino,Fabio Manfredini,Carmine Zoccali
出处
期刊:Clinical Journal of The American Society of Nephrology
[American Society of Nephrology]
日期:2022-08-01
卷期号:17 (8): 1176-1182
被引量:12
摘要
Background and objectives In the EXerCise Introduction to Enhance Performance in Dialysis (EXCITE) trial, a simple, personalized 6-month walking exercise program at home during the day off of dialysis improved the functional status and the risk for hospitalization in patients with kidney failure. In this post-trial observational study, we tested whether the same intervention was associated with a lower long-term risk of death or hospitalization (combined end point) during a follow-up extended up to 36 months. Design, setting, participants, & measurements In total, 227 patients (exercise, n =104; control, n =123) completed the 6-month trial and entered the post-trial observational study. Data were analyzed by unadjusted and adjusted Cox regression analyses and Bayesian analysis. Results In the long-term observation (up to 36 months), 134 events were recorded (eight deaths not preceded by hospitalization and 126 hospitalizations, which were followed by death in 38 cases). The long-term risk for hospitalization or death was 29% lower (hazard ratio, 0.71; 95% confidence interval, 0.50 to 1.00), and in an analysis stratified by adherence to the walking exercise program during the 6-month trial, the subgroup with high adherence (>60% of prescribed sessions) had a 45% lower risk as compared with the control group (hazard ratio, 0.55; 95% confidence interval, 0.35 to 0.87). A Bayesian analysis showed that the posterior probability of a hazard ratio of 0.71 (95% confidence interval, 0.50 to 1.00) for the risk of the composite outcome observed in the post-trial observational study was 93% under the conservative prior and 97% under the optimistic prior. Sensitivity analyses restricted to the risk of hospitalization only or censoring patients at the time of transplantation fully confirmed these findings. Conclusions A simple, personalized, home-based, low-intensity exercise program was associated with a lower risk of hospitalization. Clinical Trial registry name and registration number: EXerCise Introduction to Enhance Performance in Dialysis (EXCITE), NCT01255969
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