539 - Associations between Self-Reported Physical Activity and Echocardiogram Measures in Pediatric CKD

Publication Number: 4527.539

Amy Kogon, Childrens Hospital of Philadelphia, Wynnewood, PA, United States; Jennifer Roem, Bloomberg School of Public Health, Baltimore, MD, United States; Michael Schneider, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Babette S.. Zemel, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; Susan Furth, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Bradley A. Warady, Children's Mercy Kansas City, Kansas City, MO, United States; Sandra Amaral, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Mark Mitsnefes, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Jonathan Mitchell, CHOP, Philadelphia, PA, United States

Background: In adults with chronic kidney disease (CKD), lower physical activity levels are associated with higher risks of cardiovascular events, CKD progression, and mortality. Given that children with CKD are particularly inactive, the impact of physical activity on cardiovascular outcomes in pediatric CKD needs to be investigated.

Objective: To quantify the longitudinal associations of echocardiogram measures with self-reported moderate physical activity (MPA) and vigorous physical activity (VPA).

Design/Methods: Physical activity exposures (MPA and VPA) were assessed by self-report and parent report at annual study visits. Echocardiogram was obtained at every other annual visit starting in the second year. Linear regression, with generalized estimating equations to account for repeated assessments among individuals, was used to quantify the associations of MPA and VPA with the primary outcome, left ventricular mass index Z-score (LVMIz) and secondary outcomes [relative wall thickness (RWT), left ventricular internal diameter in diastole (LVIDd), posterior wall thickness (LVPWd), and interventricular septal thickness (IVSd)].

Results: Echocardiograms were performed at 1,019 visits among 600 participants aged ≥6 years (median 1 visit [IQR 1-2]; up to 5 visits per participant). Table 1 shows baseline data by MPA. Participants reporting 6-7 days/week of MPA had lower LVMIz than those reporting < 2 days/week (unadjusted β=- 0.21 [95% CI: -0.39, -0.03], p=0.025; β=- 0.17 lower [-0.34, 0.01], p=0.058). VPA was not associated with LVMIz. (Table 2). Higher MPA and VPA were significantly associated with lower RWT. VPA 6-7 days/week was significantly associated with higher LVIDd.

Conclusion(s): Self-reported daily physical activity, even at moderate intensity, is associated with more favorable echocardiogram measures in children with CKD. These findings support the promotion of daily physical activity as an important strategy to improve cardiovascular health in pediatric CKD.

Table 1. Descriptive characteristics of study population at first available visit, overall and by moderate physical activity categories.


Table 2. Associations between LVMIz and MPA and VPA. N=1019 kid-visits contributed by 600 kids.


Table 3. Associations of Secondary ECHO outcomes (RWT, LVIDd, LVPWd, IVSd) and Moderate Physical activity using linear regression with GEE (exchangeable correlation and robust standard errors). N=1019 kid-visits contributed by 600 kids.