Pediatric Nephrology

, Volume 31, Issue 5, pp 801–808 | Cite as

Physical activity and screen time in adolescents in the chronic kidney disease in children (CKiD) cohort

  • Stephanie L. ClarkEmail author
  • Michelle R. Denburg
  • Susan L. Furth
Original Article



Self-reported physical activity (PA) and screen time exposure in adolescents with chronic kidney disease (CKD) has not been evaluated.


We performed a cross-sectional analysis of PA and screen time in 224 adolescents at entry into the Chronic Kidney Disease in Children (CKiD) cohort. We compared proportions of CKiD vs. healthy 2012 National Health and Nutrition Examination Survey (NHANES) participants reporting the recommended 60 min of PA 7 days/week or ≤ 2 h/day of entertainment screen time (binomial probability test). Within CKiD, we assessed correlates of PA and screen time using multivariable logistic and linear regression and examined longitudinal data for 136 participants.


Median age of CKiD participants was 15 years, and 60 % were male. Median estimated glomerular filtration rate (eGFR) was 41.3 (IQR 30.8, 52.3) ml/min/1.73 m2. Only 13 % of CKiD participants met recommendations for PA vs. 25 % of NHANES (p < 0.001), while 98 % in CKiD exceeded the recommended screen time vs. 73 % in NHANES (p < 0.001). Within CKiD, obesity (p = 0.04) and lower eGFR (p = 0.02) were independently associated with greater screen time.


Adolescents with CKD engage in significantly less PA and greater screen time than healthy youth in the United States, and this may worsen over time.


Chronic kidney disease Pediatric Physical activity Cardiovascular risk factors Cardiovascular disease 



Data in this manuscript were collected by the CKiD prospective cohort study with clinical coordinating centers (principal investigators) at Children’s Mercy Hospital and the University of Missouri-Kansas City (Bradley Warady), Children’s Hospital of Philadelphia (Susan Furth), Central Biochemistry Laboratory (George Schwartz) at the University of Rochester Medical Center, and the data coordinating center (Alvaro Muñoz) at the Johns Hopkins Bloomberg School of Public Health.

The CKiD study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute (U01-DK66143, U01-DK66174, U01-DK82194, U01-DK66116).

This project was supported by NIH grants T32 DK007006 (SLC), NIH Grants K23 DK093556 (MRD), and K24 DK078737 (SLF). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

The Children’s Hospital of Philadelphia Institutional Review Board determined that this study met eligibility criteria for exemption according to 45 CFR 102(f).

Compliance with ethical standards

The Children’s Hospital of Philadelphia Institutional Review Board determined that this study met eligibility criteria for exemption according to 45 CFR 102(f).


The authors receive funding from the following sponsors for research outside the submitted work: Genentech, Inc (MRD) and Mallinckrodt Pharmaceuticals (MRD, SLF). The authors have the following consultancy agreements: Infiniti Medical (MRD). The remaining authors have no conflicts of interest to disclose.


  1. 1.
    U S Renal Data System, USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 20123. Retrieved from
  2. 2.
    Warady BA, Chadha V (2007) Chronic kidney disease in children: the global perspective. Pediatr Nephrol 22(12):1999–2009CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hooper DK, Williams JC, Carle AC, Amaral S, Chand DH, Ferris ME, Patel HP, Licht C, Barletta GM, Zitterman V, Mitsnefes M, Patel UD (2013) The quality of cardiovascular disease care for adolescents with kidney disease: a Midwest pediatric nephrology consortium study. Pediatr Nephrol 28:939–949CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Greenbaum LA, Warady BA, Furth SL (2002) Current advances in chronic kidney disease in children: growth, cardiovascular, and neurocognitive risk factors. Semin Nephrol 29(4):425–434CrossRefGoogle Scholar
  5. 5.
    Mitsnefes MM (2002) Pediatric end-stage renal disease: heart as a target. J Pediatr 141:162–164CrossRefPubMedGoogle Scholar
  6. 6.
    Flynn JT (2006) Cardiovascular disease in children with chronic renal failure. Growth Horm IGF Res 16:S84–S90CrossRefPubMedGoogle Scholar
  7. 7.
    Parekh RS, Carroll CE, Wolfe RA, Port FK (2002) Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatr 141:191–197CrossRefPubMedGoogle Scholar
  8. 8.
    Groothoff JW, Gruppen MP, Offringa M, Hutten J, Lilien MR, Van De Kar NJ, Wolff ED, Davin JC, Heymans HS (2002) Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study. Kidney Int 61:621–629CrossRefPubMedGoogle Scholar
  9. 9.
    McDonald SP, Craig JC, Australian and New Zealand Paediatric Nephrology Association (2004) Long-term survival of children with end-stage renal disease. N Engl J Med 350(26):2654–2662CrossRefPubMedGoogle Scholar
  10. 10.
    Mitsnefes MM, Laskin BL, Dahhou M, Zhang X, Foster BJ (2013) Mortality risk among children initially treated with dialysis for end-stage kidney disease, 1990–2010. JAMA 309(18):1921–1929CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Querfeld U (2001) Undertreatment of cardiac risk factors in adolescents with renal failure. Perit Dial Int 21(3 Suppl):S285–S289PubMedGoogle Scholar
  12. 12.
    Beddhu S, Wei G, Marcus RL, Chonchol M, Greene T (2015) Light-intensity physical activities and mortality in the United States general population and CKD subpopulation. Clin J Am Soc Nephrol. doi: 10.2215/CJN.08410814 PubMedGoogle Scholar
  13. 13.
    Clapp E, Bevington A, Smith AC (2012) Exercise for children with chronic kidney disease and end-stage renal disease. Pediatr Nephrol 27:165–172CrossRefPubMedGoogle Scholar
  14. 14.
    Delgado C, Johansen KL (2012) Barriers to exercise participation among dialysis patients. Nephrol Dial Transplant 27:1152–1157CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Johansen KL, Chertow GM, da Silva M, Carey S, Painter P (2001) Determinants of physical performance in ambulatory patients on hemodialysis. Kidney Int 60:1586–1591CrossRefPubMedGoogle Scholar
  16. 16.
    Williams AD, Fassett RG, Coombes JS (2014) Exercise in CKD: why is it important and how should it be delivered? Am J Kidney Dis 64(3):329–331CrossRefPubMedGoogle Scholar
  17. 17.
    Heiwe S, Jacobson SH (2014) Exercise training in adults with CKD: a systematic review and meta-analysis. Am J Kidney Dis 63(3):383–393CrossRefGoogle Scholar
  18. 18.
    Howden EJ, Coombes JS, Strand H, Douglas B, Campbell KL, Isbel NM (2014) Exercise training in CKD: efficacy, adherence, and safety. Am J Kidney Dis. doi: 10.1053/j.ajkd.2014.09.017 PubMedGoogle Scholar
  19. 19.
    Greenwood SA, Koufaki P, Mercer TH, MacLaughlin HL, Rush R, Lindup H, O’Connor E, Jones C, Hendry BM, Macdougall IC, Cairns HS (2014) Effect of exercise training on estimated GFR, vascular health and cardiorespiratory fitness in patients with CKD: a pilot randomized controlled trial. Am J Kidney Dis. doi: 10.1053/j.ajkd.2014.07.015 PubMedGoogle Scholar
  20. 20.
    Watson EL, Greening NJ, Viana JL, Aulakh J, Bodicoat DH, Barratt J, Feehally J, Smith AC (2014) Progressive resistance exercise training in CKD: a feasibility study. Am J Kidney Dis. doi: 10.1053/j.ajkd.2014.10.019 PubMedGoogle Scholar
  21. 21.
    Jhamb M, Weiner DE (2014) Exercise to improve physical function and quality of life in CKD. Clin J Am Soc Nephrol 9:2023–2024CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Rossi AP, Burris DD, Lucas FL, Crocker GA, Wasserman JC (2014) Effects of a renal rehabilitation exercise program in patients with CKD: a randomized, controlled trial. Clin J Am Soc Nephrol 9:2052–2058CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Viana JL, Kosmadakis GC, Watson EL, Bevington A, Feehally J, Bishop NC, Smith AC (2014) Evidence for anti-inflammatory effects of exercise in CKD. J Am Soc Nephrol 25:2121–2130CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    KDIGO (2013) 2012 Clinical practice guidelines for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3(1):73–90CrossRefGoogle Scholar
  25. 25.
    Morishita Y, Numata A, Miki A, Okada M, Ishibashi K, Takemoto F, Ando Y, Muto S, Nagata D, Kusano E (2014) Primary care physicians’ own exercise habits influence exercise counseling for patients with chronic kidney disease: a cross-sectional study. BMC Nephrol 15:48–54CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Greenwood SA, Koufaki P, Rush R, Macdougall IC, Mercer TH (2014) Exercise counselling practices for patients with chronic kidney disease in the UK: a renal multidisciplinary team perspective. Nephron Clin Pract 128:67–72CrossRefPubMedGoogle Scholar
  27. 27.
    Aucella F, Gesuete A, Battaglia Y (2014) A “nephrological” approach to physical activity. Kidney Blood Press Res 39:189–196CrossRefPubMedGoogle Scholar
  28. 28.
    U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Accessed from on 12 April 2015
  29. 29.
    Fakhouri THI, Hughes JP, Burt VL, Song M, Fulton JE, Ogden CL (2014) Physical activity in U.S. youth aged 12–15 years, 2012. NCHS data brief, no. 141. National Center for Health Statistics, HyattsvilleGoogle Scholar
  30. 30.
    Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescent (2011) Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 128(Suppl 6):S1–S44Google Scholar
  31. 31.
    Herrick KA, Fakhouri THI, Carlson SA, Fulton JE (2014) TV watching and computer use in U.S. youth aged 12–15, 2012. NCHS data brief, no 157. National Center for Health Statistics, HyattsvilleGoogle Scholar
  32. 32.
    Council on Communications and Media (2013) Children, adolescents, and the media. Pediatrics 132(5):958–961CrossRefGoogle Scholar
  33. 33.
    Wong CS, Gipson DS, Gillen DL, Emerson S, Koepsell T, Sherrard DJ, Watkins SL, Stehman-Breen C (2000) Anthropometric measures and risk of death in children with end-stage renal disease. Am J Kidney Dis 36:811–819CrossRefPubMedGoogle Scholar
  34. 34.
    Foster BJ, Kalkwarf HJ, Shults J, Zemel BS, Wetzsteon RJ, Thayu M, Foerster DL, Leonard MB (2011) Association of chronic kidney disease with muscle deficits in children. J Am Soc Nephrol 22:377–386CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Lee DY, Wetzsteon RJ, Zemel BS, Shults J, Organ JM, Foster BJ, Herskovitz RM, Foerster DL, Leonard MB (2015) Muscle torque relative to cross-sectional area and the functional muscle-bone unit in children and adolescents with chronic kidney disease. J Bone Miner Res 30(3):575–83CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Painter P, Krasnoff J, Mathias R (2007) Exercise capacity and physical fitness in pediatric dialysis and kidney transplant patients. Pediatr Nephrol 22:1030–1039CrossRefPubMedGoogle Scholar
  37. 37.
    van Bergen M, Takken T, Engelbert R, Groothoff J, Nauta J, van Hoeck K, Helders P, Lilien M (2009) Exercise training in pediatric patients with end-stage renal disease. Pediatr Nephrol 24:619–22CrossRefPubMedGoogle Scholar
  38. 38.
    Goldstein SL, Montgomery LR (2009) A pilot study of twice-weekly exercise during hemodialysis in children. Pediatr Nephrol 24:833–839CrossRefPubMedGoogle Scholar
  39. 39.
    Schaar B, Feldkötter M, Nonn JM, Hoppe B (2011) Cardiorespiratory capacity in children and adolescents on maintenance hemodialysis. Nephrol Dial Transplant 26:3701–3708CrossRefPubMedGoogle Scholar
  40. 40.
    Akber A, Portale AA, Johansen KL (2012) Pedometer-assessed physical activity in children and young adults with CKD. Clin J Am Soc Nephrol 7:720–726CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Lau KK, Obeid J, Breithaupt P, Belostotsky V, Arora S, Nguyen T, Timmons BW (2014) Effects of acute exercise on markers of inflammation in pediatric chronic kidney disease: a pilot study. Pediatr Nephrol. doi: 10.1007/s00467-014-2971-8 Google Scholar
  42. 42. Chronic Kidney Disease in Children Prospective Cohort Study (CKiD). Retrieved from on 18 March 2015.
  43. 43.
    Borrud L, Chiappa M, Burt V, Gahche J, Zipf G, Johnson CL, Dohrmann SM (2014) National Health and Nutrition Examination Survey: National Youth Fitness Survey plan, operations, and analysis, 2012. National Center for Health Statistics. Vital Health Stat 2(163)Google Scholar
  44. 44.
    Denburg MR, Kumar J, Thomas J, Brooks ER, Skversky A, Portale AA, Salusky IB, Warady BA, Furth SL, Leonard MB (2015) Fracture burden and risk factors in childhood chronic kidney disease: results from the CKiD cohort study. J Am Soc Nephrol. doi: 10.1681/ASN.2015020152 PubMedGoogle Scholar
  45. 45.
    Kokkinos P, Faselis C, Myers J, Sui X, Zhang J, Tsimploulis A, Chawla L, Palant C (2015) Exercise capacity and risk of chronic kidney disease in US veterans: a cohort study. Mayo Clin Proc 90(4):461–468CrossRefPubMedGoogle Scholar

Copyright information

© IPNA 2015

Authors and Affiliations

  • Stephanie L. Clark
    • 1
    • 2
    Email author
  • Michelle R. Denburg
    • 1
    • 2
  • Susan L. Furth
    • 1
    • 2
  1. 1.Division of NephrologyThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA

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