The Effect of Physical Activity Level Evaluated by Wrist-wearable Devices on Cardiovascular Disease Risk and Other Outcomes in Peritoneal Dialysis Patients

The composite endpoint of cardiovascular events includes cardiovascular death, non-fatal myocardial infarction, heart failure, stroke, valve replacement surgery, and coronary artery bypass surgery. Planning to establish a terminal endpoint assessment group to review the medical records of each patient, with two physicians independently assessing the endpoints for each case.

Cardiac Troponin I (cTnI) is a highly specific biomarker used to assess myocardial injury. It is a subunit of the troponin complex that regulates cardiac muscle contraction. cTnI is uniquely expressed in cardiac muscle and is released into the bloodstream during myocardial cell damage, making it a critical indicator of myocardial injury. Levels of high-sensitivity cardiac troponin I will be evaluated in ug/L.

A heme-containing protein found in cardiac and skeletal muscle, released very early during muscle injury. Levels of myoglobin will be evaluated in ug/L.

A cardiac-specific isoenzyme of CK, more specific to myocardial tissue than total CK. Levels of CK-MB will be evaluated in ug/L.

An enzyme found in various tissues, including skeletal and cardiac muscles. It catalyzes ATP production during muscle contraction. Levels of CK will be evaluated in ug/L.

Parameters from echocardiogram will be collected including posterior wall thickness in millimeter, septal thickness in millimeter, Left Ventricle Length in millimeter, Left Atrium length in millimeter, Left Ventricle Mass in gram, left ventricular diastolic volume in milliliter, left ventricular systolic volume in milliliter, left ventricular ejection fraction in percent, ejection volume in milliliter and E/A ratio.

The Mini-Mental State Examination (MMSE) is a widely used tool for assessing cognitive function. It is commonly employed in clinical and research settings to screen for cognitive impairment, monitor cognitive changes over time, and assess the severity of cognitive dysfunction.The MMSE has a minimum score of 0 and a maximum score of 30. Higher scores indicate better cognitive function, while lower scores suggest greater cognitive impairment.

General guidelines for interpreting MMSE scores are:

• 24-30: No cognitive impairment
• 18-23: Mild cognitive impairment
• 0-17: Severe cognitive impairment

The MoCA is a screening tool for detecting mild cognitive impairment (MCI) and early dementia.The MoCA has a maximum score of 30. A score of 26 or higher generally indicates normal cognitive function.Scores below 26 suggest varying degrees of cognitive impairment, though age, education, and cultural differences can affect interpretation. Higher scores reflect better cognitive performance. Lower scores indicate greater cognitive impairment.

The AVLT-H is used to evaluate verbal memory, learning, and recall. It is a variant of the traditional AVLT adapted for specific populations. It assesses immediate recall, delayed recall, and recognition memory through a list-learning paradigm.The total score depends on the number of correct responses during the recall and recognition phases. Higher scores indicate better memory performance and learning ability.

TMT-B measures executive function, specifically cognitive flexibility, attention, and task-switching ability.The score is the time taken (in seconds) to complete the task. Errors must be corrected, which can increase the time. Lower scores (shorter completion time) indicate better executive function. Higher scores (longer completion time) suggest poorer cognitive flexibility or attention.

Tau is the marker of neuronal injury and tauopathy. Lower levels are generally not diagnostic but may indicate absence of disease.Total Tau (t-Tau): Reflects overall neuronal injury. Phosphorylated Tau (p-Tau): Specifically associated with Alzheimer's disease pathology.

Non-specific marker of axonal damage, elevated in numerous neurological diseases, including multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Alzheimer's, and traumatic brain injury.

Marker of reactive astrocytosis, a process where astrocytes become activated in response to brain injury or disease. Elevated in conditions with neuroinflammation, such as MS, traumatic brain injury, and Alzheimer's.