This study has several limitations; first, the activity monitor was worn on the hip, which might limit its ability to detect upper body movements. Second, the sampling of different racial and ethnic groups was limited, and this study was focused on relatively healthy non-diabetic and diabetic MHD patients. Among the strengths of this study, very few other studies have examined relationships between daily physical activity and physical performance in MHD patients. This study is one of the few that used an instrument to measure daily activity. Our sample size of MHD patients was rather large. Since relatively healthy MHD patients were studied, we were able, to some extent, to separate the effects of end-stage kidney disease and MHD treatment on daily physical activity and physical performance from other common comorbid conditions that afflict MHD patients, such as protein-energy wasting, severe heart disease, strokes, amputations, or emotional depression.