PROFILES IN MOTION: TAILORING EXERCISE FOR THE MANY FACES OF CHRONIC KIDNEY DISEASE

https://youtu.be/gsuOy47HOcM INTRODUCTION Chronic kidney disease (CKD) affects over 800 million people globally and contributes to high rates of disability and cardiac mortality. While exercise can help preserve independence and reduce cardiac risk, the medical complexity of this cohort makes exercise prescription difficult. This study aimed to identify clinically recognisable profiles from comorbidity, physical function and symptom data that influence exercise prescription, and to evaluate their association with subjective independence. METHODS This was a retrospective analysis of outpatient data from adults with CKD stages 1-5. Variables included clinician-documented comorbidities; kidney function; albuminuria (proxy for progressive CKD risk); demographics (age, sex); symptoms (immobility and pain); and Short Physical Performance Battery (SPPB) scores. Principal component analysis (PCA) was used to identify common profiles (eigenvalue ≥1; variable loadings ≥0.35). Multivariable linear regression examined associations between PCA-derived profiles and subjective independence [Kidney Disease Quality of Life questionnaire - Activities of Daily Living composite (KDQOL-ADL)]. RESULTS We analysed records from 432 adult CKD outpatients (median age 75 years [IQR: 65-82], 41% female), each with a median of 6 comorbidities (IQR: 5-8). PCA identified six profiles which were assigned descriptive umbrella terms as follows: frailty with advanced CKD [poor SPPB, high symptom scores, low kidney function]; atherosclerotic conditions [coronary artery, ischaemic heart, and vascular diseases]; cardiac dysfunction [valvular diseases, heart failure, arrhythmia], mental health disorders [mood, anxiety, stress]; musculoskeletal conditions [arthropathies, osteopathies, spinal disorders, pain]; and high-risk progressive CKD [glucose intolerance, hypertension, hyperlipidaemia, albuminuria, neuropathy]. Regression demonstrated low KDQOL-ADL scores were significantly (p