Table 3.

Summary of findings: association of PA and mortality outcomes

Study	RRT	Confounders	Main findings	Deaths n (%)	Adjusted All-cause mortality HR or RR [95 % CI]	Adjusted CV mortality HR [95 % CI]
Tentori et al. (2010) [20]	HD	Age, sex, black (Y/N), ESRD duration, BMI, 14 comorbid conditions (Y/N)2, albumin, phosphorus, calcium, creatinine, Hgb, catheter use (Y/N), smoker (Y/N), some college education (Y/N), employed (Y/N), private insurance (Y/N), lives alone (Y/N) and able to walk (Y/N)	All-cause mortality risk ↓ with ↑ PA (exercise frequency)	4143 (19.8)9	Reference: non-regular exercise (n = 10,999) Regular exercise (≥ 1 time/wk) (n = 9921): 0.73 [0.69–0.78] Reference: <1time/wk (n = 10,999) 1 time/wk (n = 2205): 0.82 [0.73–0.91] 2–3 times/wk (n = 3558): 0.72 [0.66–0.79] 4–5 times/wk (n = 1201): 0.73 [0.62–0.86] 6–7 times/wk (n = 2957): 0.69 [0.63–0.76]
Lopes et al. (2014) [21]		Region3, age, sex, black (Y/N), smoker (Y/N), employed (Y/N), some college education (Y/N), lives alone (Y/N), assistance with walking (Y/N), time on HD, strength/flexibility activities (Y/N), BMI, 14 comorbid conditions2, catheter use (Y/N), Hgb, Kt/V, creatinine, albumin, calcium, systolic BP < 120mmHg (Y/N), systolic BP > 160mmHg (Y/N) phosphorus, PTH and nPCR	All-cause mortality risk ↓ with ↑PA	Never/rarely active: 427 (25.9) Infrequently active: 93 (15.5) Sometimes active: 143 (14.8) Often active: 191 (13.9) Very active: 119 (10.1)	Reference: never/rarely active (n = 1649) Infrequently active (n = 599): 0.89 [0.72–1.10] Sometimes active (n = 969): 0.84 [0.67–1.05] Often active (n = 1373): 0.81 [0.68–0.96] Very active (n = 1173): 0.60 [0.47–0.77]
Kutner et al. (2016) [22]		Age, sex, race (White, Black, other), college education (Y/N), current smoker (Y/N), participant clinic, BMI, diabetes (Y/N), CV comorbidity (Y/N)4, lupus/rheumatoid arthritis (Y/N), COPD (Y/N), cancer (Y/N), ESRD duration, catheter use (Y/N), hours wk/HD treatment	All-cause mortality risk ↓ in active patients	Inactive: 67 (18.4) Active: 43 (11.0)	Reference: inactive (n = 364) Active (n = 391): 0.61 [0.40–0.93]
Zhang et al. (2017) [23]		Age	All-cause mortality risk ↓ with ↑ light and overall PA	133 (42.0)9	Every hour/wk increase of light PA: 0.69 [0.49–0.98] Every Kcal/kg/day increase of overall PA: 0.66 [0.45–0.95]
Matsuzawa et al. (2018) [24]		Age, sex, time on HD, BMI, diabetes (Y/N), peripheral vascular disease (Y/N), CBV accident/transient ischemic attack (Y/N), geriatric nutritional risk index, and comorbidity score	All-cause mortality risk ↓ with ↑steps/day	< 4000 steps/day: 61 (39.9) ≥ 4000 steps/day: 17 (13.0)	Reference: <4000 steps/day (n = 153) ≥ 4000 steps/day (n = 129): 0.42 [0.22–0.82] Every increase of 1000 steps/day: 0.84 [0.74–0.96]
Johansen et al. (2019) [25]		Age, sex, race (Black, White, Asian, other), Hispanic (Y/N), BMI, time on HD, diabetes (Y/N), atherosclerotic heart disease (Y/N), heart failure (Y/N), catheter use (Y/N), albumin	All-cause mortality risk is related with all frailty components All-cause mortality risk ↓ in active patients	204 (28.1)9	Reference: inactive (n = 297) Active (n = 430): 0.70 [0.53–0.93]
Stack et al. (2005) [26]	HD + PD	Age, sex, race (White, Black, Asian), cause of ESRD (glomerulonephritis, diabetes, hypertension), congestive heart failure (Y/N), coronary artery disease (Y/N), peripheral vascular disease (Y/N), left ventricular hypertrophy (Y/N), undernourished (Y/N, caregiver subjective opinion), albumin, phosphorus and hematocrit	All-cause mortality risk ↓ for patients exercising 2–3 times/wk. No significant results for 4–5 times/wk and daily exercise. No significant results for CV mortality.	1366 (57.3)9	Reference: ≤1time/wk (n = 1333) 2-3times/wk (n = 437): 0.74 [0.58–0.95] 4-5times/wk (n = 134): 0.70 [0.47–1.04] Daily (n = 482): 1.06 [0.86–1.30]	2-3times/wk: 0.80 [0.58–1.08]1 (Reference: ≤1time/wk)
Brar et al. 2019 [27]		Age, sex, albumin, hemoglobin and number of comorbidities	No significant reduction in all-cause mortality risk for active patients	38 (34.9)9	Reference: inactive Active: 0.55 [0.27–1.13]
Zelle et al. (2011) [28]	KT	Age, sex, history of CV events5 (Y/N), insulin concentration, systolic BP, waist circumference, triglycerides, smoker (Y/N), CRP, Framingham risk score, creatinine clearance, urinary protein excretion, 24-h urinary creatinine	All-cause and CV mortality risk ↓ with ↑PA	81 (15.0)9	Every increase of 1 MET-min/day: 0.75 [0.60–0.94]	Every increase of 1 MET-min/day: 0.62 [0.45–0.86]
Rosas et al. (2012) [29]		Recipient and donor age, African American (Y/N), sex, diabetes (Y/N), dialysis duration, ever smoked (Y/N), BMI, delayed graft function6 (Y/N)	All-cause mortality risk ↓ with ↑PA at the time of kidney transplantation	Inactive: 61 (36.3) Moderate: 39 (23.3) Active: 28 (16.3)	Reference: inactive (n = 169) Moderate (n = 166): 0.87 [0.56–1.35] Active (n = 172): 0.52 [0.31–0.87] Every 10-unit increase in PASE score: 0.96 [0.92–0.99]
Byambasukh et al. (2020) [19]		Age, sex, eGFR, urinary protein excretion, time between transplantation and baseline, primary renal disease7, acute rejection (Y/N), pre-emptive transplantation (Y/N), living donor (Y/N), current smoker (Y/N), total alcohol consumption, total energy intake, immunosuppressive medication (Y/N) 8, systolic BP, use of antihypertensive drugs (Y/N), triglycerides, HDL-C, BMI, waist circumference, 24-h creatinine excretion	All-cause and CV mortality risk ↓ with ↑PA	129 (19.8)9	Reference: inactive (n = 246) Less active (n = 201): 0.45 [0.29–0.70] Active (n = 203): 0.44 [0.28–0.69]	Less active: 0.55 [0.26–1.16] Active: 0.44 [0.19–0.99] (Reference: inactive)

¹Data not reported for other PA categories: 4-5times/wk and daily PA (results were not significant); ²diabetes, hypertension, coronary artery disease, congestive heart failure, other cardiovascular disease, peripheral vascular disease, cerebrovascular disease, recurrent cellulitis, GI bleed, lung disease, neurologic disorder, depression, other psychiatric disorders, cancer other than skin, HIV; ³Europe, Australia/New Zealand, Japan or North America; ⁴congestive heart failure, coronary artery disease, cerebrovascular accident, peripheral vascular disease, other cardiac diseases; ⁵myocardial infarction or transient ischemic attack/CBV accident; ⁶need for dialysis during the 1st week after transplantation; ⁷glomerulosclerosis, glomerulonephritis, tubulointerstitial nephritis, polycystic kidney disease, renal hypodysplasia, renavascular diseases, diabetes, others; ⁸calcineurin inhibitors, prednisolone; ⁹data not provided for each PA group

HR hazard ratio; RR relative risk; CI confidence interval; CV cardiovascular; ESRD end-stage renal disease; BMI body mass index; BP blood pressure; PTH parathyroid hormone; nPCR normalized protein catabolic rate; PA physical activity; COPD chronic obstructive pulmonary disease; HD hemodialysis; CBV cerebrovascular; CRP C-reactive protein; MET metabolic equivalents