Association Between Physical Activity Levels and Mortality and Cardiovascular Disease in Chronic Kidney Disease: A Protocol for a Systematic Review and Meta-Analysis

TL;DR

This study will review evidence on how physical activity affects mortality and heart disease in people with chronic kidney disease.

Contribution

This is the first systematic review and meta-analysis protocol to evaluate physical activity's impact on CKD outcomes.

Findings

Will assess the association between physical activity and mortality in CKD patients.

Will use meta-analysis to evaluate cardiovascular outcomes based on activity levels.

Abstract

Background/Objectives: Chronic kidney disease (CKD) affects almost 800 million people worldwide. Cardiovascular disease is the main cause of death in this population. Although physical activity is fundamental to systemic health, the evidence regarding its impact on the clinical outcomes of CKD populations is inconclusive. This protocol outlines the methodology for a systematic review and meta-analysis aimed at evaluating the association between physical activity and intensity and all-cause mortality, cardiovascular mortality, and cardiovascular disease. Methods: This protocol adheres to PRISMA-P and Cochrane Handbook guidelines and has been registered with PROSPERO (CRD420261302904). A systematic search will be conducted in MEDLINE, Scopus, Web of Science and the Cochrane Library until June 2026. Studies estimating the association between physical activity and all-cause mortality, cardiovascular mortality and cardiovascular disease in populations with CKD will be included. Two independent reviewers will perform study selection, data extraction and quality assessment using the Study Quality Assessment Tool from the United States National Institute of Health tool. The certainty of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation tool. Narrative synthesis and random-effects meta-analysis will be conducted to calculate pooled effect estimates. Random-effects meta-analyses will be performed according to the level of physical activity, and meta-regressions will be used to control for the association with major covariates. Ethical approval is not required for this study. Results: The results will provide a comprehensive synthesis of the evidence regarding the use of physical activity as a non-pharmacological intervention to modify CKD progression. Conclusions: The findings will be disseminated through peer-reviewed journals and international conferences.

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