探究不同等级体力活动对慢性肾脏病(CKD)患者预后的影响。

回顾性调查解放军总医院第一医学中心2018年5月1日至2019年5月1日期间住院的CKD患者，选取具有≥2次住院记录的患者纳入研究。收集患者首次住院时的人口学资料、临床指标、伴随疾病、肾活检病理信息、治疗方案及末次住院时的肾脏病转归，并采用国际体力问卷(IPAQ)记录CKD患者随访期间各项体力活动情况，并对代谢当量(MET)赋值。根据IPAQ标准分为低体力活动组、中体力活动组和高体力活动组，对比分析其预后差异。

本研究共纳入266例CKD患者，男性64.7%，年龄(45.23±13.09)岁。入组时患者eGFR(71.16±31.31)[ml/(min·1.73 m²]。其中，CKD 3期占32.7%(87/266)、CKD 1期31.5%(84/266)、CKD 2期24.4%(65/266)。低体力活动组39例，中体力活动组123例，高体力活动组104例，平均体力活动评分为(3 352±3 543)分。末次住院时共有106例患者eGFR下降≥30%或进入肾脏替代治疗，Kaplan-Meier生存曲线分析显示，与低体力活动组相比，中体力活动组(P＝0.009)和高体力活动组的主要终点事件发生率较低(P＝0.002)，而中、高体力活动组之间无明显差异(P＝0.709)。亚组分析显示，CKD 1～3期患者，中、高体力活动组有更好预后(P＝0.009)，而CKD4～5期患者，3组间预后差异无统计学意义(P＝0.631)。伴有糖尿病患者，中、高体力活动组较低体力活动组预后好(P＝0.002)。

CKD患者的中、高体力活动组较低体力活动组的eGFR下降更慢；CKD 1～3期患者或伴糖尿病患者中，中、高体力活动组预后好于低体力活动组。

The aim of this study was to investigate the impact of different levels of physical activity on the prognosis of chronic kidney disease (CKD) patients.

A retrospective investigation in CKD patients admitted to First Medical Center of Chinese PLA General Hospital between May 1, 2018 and May 1, 2019, was performed. Patients with ≥2 hospitalization records were selected for inclusion in the study. Demographic data, clinical indicators, concomitant diseases, pathological information of renal biopsy, treatment plan at the first hospitalization, and renal disease outcome at the last hospitalization were collected. The International Physical Activity Questionnaire (IPAQ) was used to record the physical activity of the CKD patients during follow-up, and the metabolic equivalent of task (MET) was assigned. According to the IPAQ grouping criteria, the patients were divided into low physical activity group, moderate physical activity group, and high physical activity group among which the differences in prognosis of the patients were compared and analyzed.

A total of 266 patients with CKD were enrolled in the study with 64.7% being male. The mean age of the participants was 45.23 ± 13.09 years. The estimated glomerular filtration rate (eGFR) at baseline was 71.16 ± 31.31 ml/(min·1.73 m²). Of all the patients, CKD stage 3 accounted for 32.7% (87/266), CKD stage 1 for 31.5% (84/266), and CKD stage 2 for 24.4%(65/266). There were 39 cases in the low physical activity group, 123 cases in the moderate physical activity group, and 104 cases in the high physical activity group, with an average physical activity score of 3 352±3543. During the last hospitalization, 106 patients experienced a ≥30% decline in eGFR or initiated renal replacement therapy. Kaplan-Meier survival curve analysis revealed that the incidence of major endpoint events was lower in the moderate and high physical activity groups compared with the low physical activity group (P=0.009 and P=0.002, respectively). However, there was no significant difference between the moderate and high physical activity groups (P=0.709). Subgroup analysis showed that patients with CKD stages 1-3 who engaged in moderate or high levels of physical activity had a better prognosis (P=0.009). In contrast, there was no significant difference in prognosis among the three physical activity groups in patients with CKD stages 4-5 (P=0.631). Additionally, among patients with diabetes mellitus, the moderate and high physical activity groups had a better prognosis than the low physical activity group (P=0.002).

The eGFR of the CKD patients in the moderate and high physical activity groups declined slower than that in the low physical activity group. In patients with CKD stage 1 to 3 or CKD patients complicated with diabetes, the prognosis of the moderate and high physical activity groups was better than that of the low physical activity group.