***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Prediction models for post‐kidney transplantation mortality have had limited success ( C‐statistics ≤0.70 ) . Adding objective measures of potentially modifiable factors may improve prediction and , consequently , kidney transplant ( KT ) survival through intervention . The Short Physical Performance Battery ( SPPB ) is an easily administered objective test of lower extremity function consisting of three parts ( balance , walking speed , chair st and s ) , each with scores of 0–4 , for a composite score of 0–12 , with higher scores indicating better function .  SPPB performance and frailty ( Fried frailty phenotype ) were assessed at admission for KT in a prospect i ve cohort of 719 KT recipients at Johns Hopkins Hospital ( 8/2009 to 6/2016 ) and University of Michigan ( 2/2013 to 12/2016 ) . The independent associations between SPPB impairment ( SPPB composite score ≤10 ) and composite score with post‐KT mortality were tested using adjusted competing risks models treating graft failure as a competing risk . The 5‐year posttransplantation mortality for impaired recipients was 20.6 % compared to 4.5 % for unimpaired recipients ( p < 0.001 ) . Impaired recipients had a 2.30‐fold ( adjusted hazard ratio [ aHR ] 2.30 , 95 % confidence interval [ CI ] 1.12–4.74 , p = 0.02 ) increased risk of postkidney transplantation mortality compared to unimpaired recipients . Each one‐point decrease in SPPB score was independently associated with a 1.19‐fold ( 95 % CI 1.09–1.30 , p < 0.001 ) higher risk of post‐KT mortality . SPPB‐derived lower extremity function is a potentially highly useful and modifiable objective measure for pre‐KT risk prediction BACKGROUND There is increasing evidence of the benefit of regular physical exercise in a number of long-term conditions including chronic kidney disease ( CKD ) . In CKD , this evidence has mostly come from studies in end stage patients receiving regular dialysis . There is little evidence in pre-dialysis patients with CKD Stages 4 and 5 . METHODS A prospect i ve study compared the benefits of 6 months regular walking in 40 pre-dialysis patients with CKD Stages 4 and 5 . Twenty of them were the exercising group and were compared to 20 patients who were continuing with usual physical activity . In addition , the 40 patients were r and omized to receive additional oral sodium bicarbonate ( target venous bicarbonate 29 mmol/L ) or continue with previous sodium bicarbonate treatment ( target 24 mmol/L ) . RESULTS Improvements noted after 1 month were sustained to 6 months in the 18 of 20 who completed the exercise study . These included improvements in exercise tolerance ( reduced exertion to achieve the same activity ) , weight loss , improved cardiovascular reactivity , avoiding an increase in blood pressure medication and improvements in quality of health and life and uraemic symptom scores assessed by question naire . Sodium bicarbonate supplementation did not produce any significant alterations . CONCLUSIONS This study provides further support for the broad benefits of aerobic physical exercise in CKD . More studies are needed to underst and the mechanisms of these benefits , to study whether resistance exercise will add to the benefit and to evaluate strategies to promote sustained lifestyle changes , that could ensure continued increase in habitual daily physical activity levels BACKGROUND longitudinal relationship between renal function , disability and mortality has not been evaluated . OBJECTIVE we investigated the temporal association between renal function and disability , and aim ed to identify the influence of disability on mortality according to renal function in a cohort of older Koreans . DESIGN / SETTING Korean Longitudinal Study on Health and Aging is a prospect i ve , population -based cohort . SUBJECTS community-dwelling Koreans ≥65 years of age . MAIN OUTCOME MEASURES  Korean version of activities of daily living ( ADL ) , Instrumental activities of daily living ( IADL ) and all-cause mortality . RESULTS a total of 984 participants were followed for 5 years with a 70.9 % participation rate . The participants were categorized into three groups according to their baseline estimated glomerular filtration rates ( eGFRs ) ( Group I , ≥60 ; Group II , 45 - 59 ; and Group III , < 45 ml/min/1.73 m(2 ) ) . Baseline eGFR was higher in participants who maintained functional status compared with participants who died or had disability at follow-up examination . The incidence of ADL/IADL decline was 13 , 12.5 and 29.5 % in participants who showed improvement , no change , and decline in renal function , respectively ( P = 0.01 ) . The hazard ratio for mortality in the subgroup with IADL disability was 1.87 ( 95 % CI : 1.10 - 3.20 , P = 0.022 ) in Group I , and 2.53 ( 95 % CI : 1.57 - 4.09 , P<0.001 ) in Groups II and III after adjustment . CONCLUSIONS impaired renal function was related to disability and ADL/IADL decline . The effect of ADL/IADL disability on mortality was more prominent in participants with impaired eGFR Background / Aims : Although the effect of exercise on health is well established , nephrologists seldom consider physical activity in the treatment of chronic kidney disease ( CKD ) or CKD in the presence of diabetes mellitus ( DM/CKD ) . The aim of the present study was to analyze the benefits of leisure-time physical activity ( LTPA ) in DM/CKD . Methods : A total of 445,075 adult participants who underwent a medical screening program between 1996 and 2008 were prospect ively recruited . Of these , 7,863 DM/CKD subjects were identified . Each participant was categorized according to  LTPA level ( a product of duration and intensity ) as inactive , low-active or fully active .  Hazard ratios ( HRs ) for mortality risk were calculated . Results : Fully active LTPA was associated with lower odds of DM/CKD development and lower risk of mortality among patients with DM/CKD in a dose-response relationship . The fully active and low-active DM/CKD groups had a 26 % ( HR 0.74 , 95 % CI 0.66 - 0.85 ) and 13 % ( HR 0.87 , 95 % CI 0.75 - 1.01 ) lower risk of all-cause mortality , respectively , in comparison to the inactive group . The association of exercise with mortality rate reduction was more pronounced among DM/CKD subjects ( mortality rate reduction of 446.5 per 100,000 person-years ) than among subjects with diabetes alone or CKD alone . Conclusion : Exercise , at the recommended level or more , is associated not only with lower odds of DM/CKD but also with a 26 % lower mortality risk among DM/CKD patients . Nephrologists should encourage all DM/CKD subjects to be physically active BACKGROUND In general population s , healthy lifestyle is associated with fewer adverse outcomes . We estimated the degree to which adherence to a healthy lifestyle decreases the risk of renal and cardiovascular events among adults with chronic kidney disease ( CKD ) . STUDY DESIGN Prospect i ve cohort . SETTING & PARTICIPANTS 3,006 adults enrolled in the Chronic Renal Insufficiency Cohort ( CRIC ) Study . PREDICTORS 4 lifestyle factors ( regular physical activity , body mass index [ BMI ] of 20-<25kg/m(2 ) , nonsmoking , and " healthy diet " ) , individually and in combination . OUTCOMES CKD progression ( 50 % decrease in estimated glomerular filtration rate or end-stage renal disease ) , atherosclerotic events ( myocardial infa rct ion , stroke , or peripheral arterial disease ) , and all-cause mortality . MEASUREMENTS Multivariable-adjusted Cox proportional hazards . RESULTS During a median follow-up of 4 years , we observed 726 CKD progression events , 355 atherosclerotic events , and 437 deaths . BMI ≥25kg/m(2 ) and nonsmoking were associated with reduced risk of CKD progression ( HRs of 0.75 [ 95 % CI , 0.58 - 0.97 ] and 0.61 [ 95 % CI , 0.45 - 0.82 ] for BMI s of 25 to < 30 and ≥30kg/m(2 ) , respectively , versus 20 to < 25kg/m(2 ) ; HR for nonsmoking of 0.68 [ 95 % CI , 0.55 - 0.84 ] compared to the current smoker reference group ) and reduced risk of atherosclerotic events ( HRs of 0.67 [ 95 % CI , 0.46 - 0.96 ] for BMI of 25-<30 vs 20-<25kg/m(2 ) and 0.55 [ 95 % CI , 0.40 - 0.75 ] vs current smoker ) . Factors associated with reduced all-cause mortality were regular physical activity ( HR , 0.64 [ 95 % CI , 0.52 - 0.79 ] vs inactive ) , BMI ≥30kg/m(2 ) ( HR , 0.64 [ 95 % CI , 0.43 - 0.96 ] vs 20-<25kg/m(2 ) ) , and nonsmoking ( HR , 0.45 [ 95 % CI , 0.34 - 0.60 ] vs current smoker ) . BMI < 20kg/m(2 ) was associated with increased all-cause mortality risk ( HR , 2.11 [ 95 % CI , 1.13 - 3.93 ] vs 20-<25kg/m(2 ) ) . Adherence to all 4 lifestyle factors was associated with a 68 % lower risk of all-cause mortality compared to adherence to no lifestyle factors ( HR , 0.32 ; 95 % CI , 0.11 - 0.89 ) . LIMITATIONS Lifestyle factors were measured only once . CONCLUSIONS Regular physical activity , nonsmoking , and BMI ≥25kg/m(2 ) were associated with lower risk of adverse outcomes in this cohort of individuals with CKD Background : Low physical activity ( PA ) has been associated with higher rates of cardiovascular disease ( CVD ) and mortality in the general population . Despite the benefits of kidney transplantation , kidney transplant recipients ( KTRs ) remain at elevated risk for CVD and mortality compared to individuals without kidney disease . Methods : A prospect i ve cohort of 507 adult KTRs from three academic centers completed the  Physical Activity Scale for the Elderly ( PASE ) at transplantation .  PASE scores were divided into tertiles . Results :  PA  was lower with older age , history of CVD , smoking , and diabetes . During the median 8-year follow-up period , 128 individuals died , among whom 101 had a functioning allograft . In multivariable Cox regression for all-cause mortality , greater  PA  was strongly associated with better survival ( HR : 0.52 for most active vs. inactive tertiles , 95 % CI : 0.31–0.87 , p = 0.01 ) . Secondary analyses , in which ( 1 ) death with a functioning graft was the primary outcome , and ( 2 ) PASE scores were converted to the metabolic equivalent of task , revealed similar results . We did not find an association between change of PA after transplantation and mortality . Conclusions : PA at the time of kidney transplantation is a strong predictor of all-cause mortality and death with graft function . Evaluation of PA level among kidney transplant c and i date s may be a useful method to risk-stratify patients for survival after kidney transplantation . Kidney transplant c and i date s and recipients should also be encouraged to be physically active BACKGROUND Slow walk ( gait ) speed predicts functional decline , institutionalization , and mortality risks in the geriatric population . A gait speed evidence base for dialysis patient outcomes is needed . STUDY DESIGN Prospect i ve cohort study . SETTING & PARTICIPANTS 752 prevalent hemodialysis ( HD ) patients aged 20 to 92 years evaluated in 2009 to 2012 in 7 Atlanta and 7 San Francisco clinics in a US Renal Data System special study . PREDICTOR Usual walk speed in meters per second , categorized as ≥0.6 m/s ( baseline n=575 ) , < 0.6 m/s ( baseline n=94 ) , and unable to perform walk test ( baseline n=83 ) . OUTCOMES Survival ; hospitalization ; activities of daily living ( ADL ) difficulty ; 36-Item Short Form Health Survey ( SF-36 ) Physical Function score . MEASUREMENTS Cox proportional hazards models investigated gait speed and mortality over a median follow-up of 703 days . Multivariable logistic or linear regression models estimated associations of baseline gait speed with hospitalization , need for ADL assistance , and SF-36 Physical Function score after 12 months . RESULTS Participants who walked ≥0.6 m 
    Output:
    
Although not appropriate for meta- analysis due to variance in the outcome measures reported , a coherent pattern was seen with higher mortality rates or prevalence of adverse clinical events associated with lower PA and physical function levels , irrespective of the measurement tool used .
Conclusions : In nondialysis CKD , survival rates correlate with greater PA and physical function levels .