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Zelko A, Skoumalova I, Kravcova D, Dankulincova Veselska Z, Rosenberger J, Madarasova Geckova A, van Dijk JP, Reijneveld SA. Perceptions of healthcare providers on benefits, risks and barriers regarding intradialytic exercise among haemodialysis patients. Int J Qual Stud Health Well-being 2024; 19:2287597. [PMID: 38055756 DOI: 10.1080/17482631.2023.2287597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE Clinical guidelines call for the inclusion of exercise interventions in every patient's dialysis session, but these recommendations are rarely adopted. Healthcare providers play a key role in this. Therefore, the aim of this study was to explore how healthcare providers perceive the benefits, risks and barriers of intradialytic exercise (IDE). METHODS We conducted 21 individual, semi-structured interviews with 11 nurses, 5 nephrologists, 3 training assistants and 2 managers from two dialysis centres in Slovakia. Verbatim transcripts of digitally recorded interviews were thematically analysed using MAXQDA®. RESULTS Participants reported the benefits of IDE as improvements in patients' physical and psychosocial functioning, independence and self-efficacy, clinical profile and quality of therapy. As risks of IDE, they most frequently reported exercise-related damage to vascular access, insufficient individualization of training and musculoskeletal injuries. The presence of psychological problems among patients was reported as a major barrier for initiating and maintaining patients' exercise. Other reported barriers included limitations in financial and personnel resources of haemodialysis care. CONCLUSIONS Safe and sustainable implementation of IDE, which might improve a patient's well-being, need to be prescribed in alignment with the patient's clinical profile, be delivered individually according to the patient's characteristics and requires adjustments in the available resources.
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Affiliation(s)
- Aurel Zelko
- Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ivana Skoumalova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Denisa Kravcova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Zuzana Dankulincova Veselska
- Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Jaroslav Rosenberger
- Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
- 2nd Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Fresenius Medical Care - Dialysis Services Kosice, Kosice, Slovakia
| | - Andrea Madarasova Geckova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
- Institute of Applied Psychology, Faculty of Social and Economic Sciences, Comenius University in Bratislava, Bratislava, Slovakia
| | - Jitse P van Dijk
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
| | - Sijmen A Reijneveld
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Sakkas GK, Giannaki CD, Wilund KR, Karatzaferi C. How to cultivate sustainable physical health and wellness in transplant recipients: the emerging and enduring role of exercise scientists. Curr Opin Organ Transplant 2024; 29:294-298. [PMID: 38841870 DOI: 10.1097/mot.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW The aim of the current review is to highlight the importance of exercise training as an important section of transplant recipient rehabilitation process and explain the role of the exercise scientist in the development, implementation, and assessment of the exercise regime. RECENT FINDINGS Transplant patients face a unique set of challenges in their recovery and rehabilitation process, often requiring a multifaceted approach to address the physical, emotional, and psychological aspects of their condition. Exercise training has emerged as a crucial component in the care of these patients, providing a means to improve functional capacity, enhance quality of life, and mitigate the adverse effects of transplant-related complications. Exercise scientists who are trained to assess patient's physical limitations, develop and deliver personalized exercise programs, and monitor their progress are uniquely positioned to play a crucial role in the treatment of patients with chronic conditions that require exercise training as a mean of improving and maintaining health and quality of life. SUMMARY Exercise scientists are the appropriate professionals for providing transplant recipients with the recommended exercise training for maintaining and improving their health status as part of the overall plan of long-term care and support.
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Affiliation(s)
- Giorgos K Sakkas
- Department of PA and Sports Sciences, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Christoforos D Giannaki
- Department of Life Sciences, School of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Kenneth R Wilund
- Department of Leadership, School of Nutritional Sciences and Wellness, University of Arizona, Tucson, USA
| | - Christina Karatzaferi
- Department of PA and Sports Sciences, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
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Kishi S, Kadoya H, Kashihara N. Treatment of chronic kidney disease in older populations. Nat Rev Nephrol 2024:10.1038/s41581-024-00854-w. [PMID: 38977884 DOI: 10.1038/s41581-024-00854-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 07/10/2024]
Abstract
As the world population ages, an expected increase in the prevalence of chronic kidney disease (CKD) among older individuals will pose a considerable challenge for health care systems in terms of resource allocation for disease management. Treatment strategies for older patients with CKD should ideally align with those applied to the general population, focusing on minimizing cardiovascular events and reducing the risk of progression to kidney failure. Emerging therapies, such as SGLT-2 inhibitors and GLP-1 receptor agonists, hold promise for the effective management of CKD in older individuals. In addition, non-pharmacological interventions such as nutritional and exercise therapies have a crucial role. These interventions enhance the effects of pharmacotherapy and, importantly, contribute to the maintenance of cognitive function and overall quality of life. Various factors beyond age and cognitive function must be taken into account when considering kidney replacement therapy for patients with kidney failure. Importantly, all treatment options, including dialysis, transplantation and conservative management approaches, should be tailored to the individual through patient-centred decision-making. The dynamic integration of digital technologies into medical practice has the potential to transform the management of CKD in the aging population.
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Affiliation(s)
- Seiji Kishi
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Hiroyuki Kadoya
- Department of General Geriatric Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Naoki Kashihara
- Department of Medical Science, Kawasaki Medical School, Kurashiki, Japan.
- Kawasaki Geriatric Medical Center, Kawasaki Medical School, Okayama, Japan.
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4
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Chen SH, Hsu CP, Chang HH, Liu TJ, Sun FJ, Liang YJ. The expected changes with different periods of home-based resistance exercise in patients with chronic kidney disease. J Chin Med Assoc 2024; 87:691-698. [PMID: 38965665 DOI: 10.1097/jcma.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND The comprehensive impact of prolonged home-based resistance training on individuals grappling with chronic kidney disease (CKD) have yet to be fully elucidated. This study aimed to explore the outcomes of varying exercise durations on physical performance, nutritional status, and kidney function within this specific population, encompassing patients undergoing dialysis and those affected by severe sarcopenia. METHODS This was a 1-year observational double cohort study following a 52-week longitudinal design, we enrolled 101 adult CKD outpatients. These participants were divided into two groups: the continuous group, comprising individuals who consistently exercised for over 6 months, and the interrupted group, which included those who did not sustain regular exercise for the same duration. The exercise regimen involved resistance exercises conducted at least 3 to 5 days per week, involving activities like lifting dumbbells and executing weighted wall squats. Physical activity assessments and biochemical blood tests were conducted at weeks 0, 4, 16, 28, 40, and 52 for all participants. RESULTS The continuous exercise group exhibited better handgrip strength and sit-to-stand movement compared to the interrupted group. Their estimated glomerular filtration rate stayed steady while the interrupted group was declined. Additionally, those who exercised consistently had better metabolism: higher carbon dioxide levels, increased albumin, better nutritional scores, and lower levels of blood urea nitrogen, creatinine, fasting blood glucose, and body weight. Subsequent adjustments for potential confounding factors continued to show improved physical performance and kidney function over time. CONCLUSION Our findings indicate the advantageous impact of extended resistance exercise training on overall health of CKD patients, even those on dialysis or with severe sarcopenia. Dedication to this exercise routine could improve kidney function, metabolism, and physical abilities in these patients.
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Affiliation(s)
- Shu-Hua Chen
- Department of Nephrology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Graduate Institute of Applied Science and Engineering, Department and Institute of Life Science, Fu-Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Ching-Ping Hsu
- Department of Family Medicine, MacKay Memorial Hospital, Taipei, Taiwan, ROC
| | - Hsiao-Hua Chang
- Department of Nephrology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
| | - Tai-Ju Liu
- Department of Medical Education, MacKay Memorial Hospital, Taipei, Taiwan, ROC
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan, ROC
| | - Yao-Jen Liang
- Graduate Institute of Applied Science and Engineering, Department and Institute of Life Science, Fu-Jen Catholic University, New Taipei City, Taiwan, ROC
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Zhang Y, Yu C, Li X. Kidney Aging and Chronic Kidney Disease. Int J Mol Sci 2024; 25:6585. [PMID: 38928291 PMCID: PMC11204319 DOI: 10.3390/ijms25126585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
The process of aging inevitably leads to an increase in age-related comorbidities, including chronic kidney disease (CKD). In many aspects, CKD can be considered a state of accelerated and premature aging. Aging kidney and CKD have numerous common characteristic features, ranging from pathological presentation and clinical manifestation to underlying mechanisms. The shared mechanisms underlying the process of kidney aging and the development of CKD include the increase in cellular senescence, the decrease in autophagy, mitochondrial dysfunction, and the alterations of epigenetic regulation, suggesting the existence of potential therapeutic targets that are applicable to both conditions. In this review, we provide a comprehensive overview of the common characteristics between aging kidney and CKD, encompassing morphological changes, functional alterations, and recent advancements in understanding the underlying mechanisms. Moreover, we discuss potential therapeutic strategies for targeting senescent cells in both the aging process and CKD.
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Affiliation(s)
- Yingying Zhang
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA
| | - Chen Yu
- Department of Nephrology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai 200092, China;
| | - Xiaogang Li
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA
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Knowler WC, Chen H, Bahnson JL, Kahn SE, Lewis CE, Nathan DM, Nelson RG, Pilla SJ, Bantle JP. Within and post-trial effects of an intensive lifestyle intervention on kidney disease in adults with overweight or obesity and type 2 diabetes mellitus: a secondary analysis of the Look AHEAD clinical trial. BMJ Open Diabetes Res Care 2024; 12:e004079. [PMID: 38816203 PMCID: PMC11141171 DOI: 10.1136/bmjdrc-2024-004079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION The Look AHEAD randomized clinical trial reported that an 8-year intensive lifestyle intervention (ILI) compared with diabetes support and education (DSE) in adults aged 45-76 years with type 2 diabetes and overweight/obesity delayed kidney disease progression. Here, we report long-term post-intervention follow-up for the trial's secondary outcome of kidney disease. RESEARCH DESIGN AND METHODS We examined effects of ILI (n=2570) versus DSE (n=2575) on decline in estimated glomerular filtration rate (eGFR) to <45 mL/min/1.73 m2 or need for kidney replacement therapy (KRT: dialysis or kidney transplant) during intervention and post-intervention follow-up (median 15.6 years overall). RESULTS Incidence of eGFR <45 mL/min/1.73 m2 was lower in ILI during the intervention (HR=0.80, 95% CI=0.66 to 0.98) but not post-intervention (HR=1.03, 0.86 to 1.23) or overall (HR=0.92, 0.80 to 1.04). There were no significant treatment group differences in KRT. In prespecified subgroup analyses, age×treatment interactions were significant over total follow-up: p=0.001 for eGFR <45 mL/min/1.73 m2 and p=0.01 for KRT. The 2205 participants aged >60 years at baseline had benefit in both kidney outcomes during intervention and overall (HR=0.75, 0.62 to 0.90 for eGFR <45 mL/min/1.73 m2; HR=0.62, 0.43 to 0.91 for KRT). The absolute treatment effects were greater post-intervention: ILI reduced the rate of eGFR <45 mL/min/1.73 m2 by 0.46 and 0.76 cases/100 person-years during and post-intervention, respectively; and reduced KRT by 0.15 and 0.21 cases/100 person-years. The younger participants experienced no such post-intervention benefits. CONCLUSIONS ILI reduced kidney disease progression during and following the active intervention in persons aged ≥60 years. ILI should be considered for reducing kidney disease incidence in older persons with type 2 diabetes.
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Affiliation(s)
- William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Judy L Bahnson
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Steven E Kahn
- VA Puget Sound Health Care System and University of Washington, Seattle, Washington, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David M Nathan
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
- Current: Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Scott J Pilla
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - John P Bantle
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Sato T, Ono M, Kawamura K, Naganuma W, Shishito N, Morishita S, Sasamoto Y, Kohzuki M. Impact of moderate to vigorous intensity physical activity on change in renal function in patients after acute myocardial infarction. Heart Vessels 2024; 39:393-403. [PMID: 38189923 DOI: 10.1007/s00380-023-02354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/27/2023] [Indexed: 01/09/2024]
Abstract
Acute myocardial infarction (AMI) is associated with a decline in renal function. This study aimed to investigate the impact of engaging in moderate to vigorous intensity physical activity (MVPA) for more than 30 min per day on changes in renal function during the first 3 months after AMI onset. A prospective, observational study was conducted, enrolling 87 patients (75 men; average age, 65.2 ± 12.5 years) who had experienced AMI. The cystatin C-based estimated glomerular filtration rate (eGFRcys) was collected at and 3 months after discharge. Daily MVPA was measured using triaxial accelerometers at a threshold of 3.0 Metabolic equivalent of the task for 3 months. Generalized estimating equations (GEE) were applied to evaluate the longitudinal association between the number of days per week of MVPA for 30 min or more and within-patient changes in eGFRcys. The patients were categorized into three groups based on their MVPA engagement days: 0 days (n = 20), 1-2 days (n = 14), and 3-7 days (n = 53) groups. After adjusting for potential confounding variables, GEE analysis revealed that the eGFRcys slope over 3 months was significantly higher in the 3-7 days group than in 0 days group (B = 2.9, (95% confidence interval: 1.5-4.2), p < 0.001). Similar results were obtained when MVPA time thresholds were set to 40 and 60 min. These findings suggest a significant positive effect of engaging in MVPA for 30 min or more for 3-7 days per week in the improvement of renal function after AMI onset.
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Affiliation(s)
- Toshimi Sato
- Department of Physical Therapy, Fukushima Medical University School of Health Sciences, 10-6, Sakaemachi, Fukushima, 960-8516, Japan.
| | - Masahiro Ono
- Department of Cardiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Keiichi Kawamura
- Department of Cardiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Wakako Naganuma
- Department of Cardiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Namiko Shishito
- Department of Cardiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Shinichiro Morishita
- Department of Physical Therapy, Fukushima Medical University School of Health Sciences, 10-6, Sakaemachi, Fukushima, 960-8516, Japan
| | - Yuichiro Sasamoto
- Department of Rehabilitation, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Masahiro Kohzuki
- Yamagata Prefectural University of Health Sciences, Yamagata, Japan
- Tohoku University Graduate School of Medicine, Sendai, Japan
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Gollie JM, Ryan AS, Sen S, Patel SS, Kokkinos PF, Harris-Love MO, Scholten JD, Blackman MR. Exercise for patients with chronic kidney disease: from cells to systems to function. Am J Physiol Renal Physiol 2024; 326:F420-F437. [PMID: 38205546 PMCID: PMC11208028 DOI: 10.1152/ajprenal.00302.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Chronic kidney disease (CKD) is among the leading causes of death and disability, affecting an estimated 800 million adults globally. The underlying pathophysiology of CKD is complex creating challenges to its management. Primary risk factors for the development and progression of CKD include diabetes mellitus, hypertension, age, obesity, diet, inflammation, and physical inactivity. The high prevalence of diabetes and hypertension in patients with CKD increases the risk for secondary consequences such as cardiovascular disease and peripheral neuropathy. Moreover, the increased prevalence of obesity and chronic levels of systemic inflammation in CKD have downstream effects on critical cellular functions regulating homeostasis. The combination of these factors results in the deterioration of health and functional capacity in those living with CKD. Exercise offers protective benefits for the maintenance of health and function with age, even in the presence of CKD. Despite accumulating data supporting the implementation of exercise for the promotion of health and function in patients with CKD, a thorough description of the responses and adaptations to exercise at the cellular, system, and whole body levels is currently lacking. Therefore, the purpose of this review is to provide an up-to-date comprehensive review of the effects of exercise training on vascular endothelial progenitor cells at the cellular level; cardiovascular, musculoskeletal, and neural factors at the system level; and physical function, frailty, and fatigability at the whole body level in patients with CKD.
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Affiliation(s)
- Jared M Gollie
- Research and Development Service, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, United States
- Department of Health, Human Function, and Rehabilitation Sciences, The George Washington University, Washington, District of Columbia, United States
| | - Alice S Ryan
- Department of Medicine, University of Maryland, Baltimore, Maryland, United States
- Division of Geriatrics and Palliative Medicine, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, United States
| | - Sabyasachi Sen
- Department of Medicine, Washington DC Veterans Affairs, Medical Center, Washington, District of Columbia, United States
- Department of Medicine, The George Washington University, Washington, District of Columbia, United States
| | - Samir S Patel
- Research and Development Service, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, United States
- Department of Medicine, Washington DC Veterans Affairs, Medical Center, Washington, District of Columbia, United States
- Department of Medicine, The George Washington University, Washington, District of Columbia, United States
| | - Peter F Kokkinos
- Division of Cardiology, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, United States
- Department of Kinesiology and Health, Rutgers University, New Brunswick, New Jersey, United States
| | - Michael O Harris-Love
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Geriatric Research Education and Clinical Center, Eastern Colorado Veterans Affairs Health Care System, Denver, Colorado, United States
| | - Joel D Scholten
- Physical Medicine and Rehabilitation Service, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, United States
| | - Marc R Blackman
- Research and Development Service, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, United States
- Department of Medicine, Washington DC Veterans Affairs, Medical Center, Washington, District of Columbia, United States
- Department of Medicine, The George Washington University, Washington, District of Columbia, United States
- Department of Medicine, Georgetown University, Washington, District of Columbia, United States
- Department of Rehabilitation Medicine, Georgetown University, Washington, District of Columbia, United States
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Bai P, Ning X, Gao R, Shao X, Zhou S, Li J, Lin Y, Liu H, Zhang M, Yu P. Association between circadian physical activity patterns and cancer incidence through regulation of inflammation: A UK biobank study. Prev Med 2024; 179:107831. [PMID: 38145876 DOI: 10.1016/j.ypmed.2023.107831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Physical activity (PA) has been linked with cancer incidence. However, the effects and mechanisms underpinning circadian PA trajectories on cancer remain elusive. This study aimed to explore the optimal PA patterns in reducing cancer incidence and the associated potential mediators. METHODS Between 2006 and 2010, 502,400 participants were recruited from the UK Biobank. Out of these, 102,323 participants wore accelerometers, which allowed for collecting acceleration data continuously over 7 days. After excluding participants with previous cancer history, 96,687 participants were included in K-means cluster analysis to identify PA trajectories. The association between PA and cancer incidence was assessed using Cox regression analysis. Additionally, we investigated the mediating role of inflammation. RESULTS A total of 5995 cancer cases were recorded during a median follow-up of 7.1 years. Four distinct PA trajectories (persistent low, single peak, double peak, and vigorous) were identified. The ideal PA patterns reduced the risk of 7 out of 17 site-specific cancers, with the lowest hazard ratios and 95% confidence intervals of cancer for bladder (0.59, 0.40-0.86), breast (0.73, 0.60-0.89), kidney (0.45, 0.26-0.78), lung (0.59, 0.41-0.84), myeloma (0.49, 0.27-0.88), and oral & pharynx (0.51, 0.26-0.98) in the vigorous pattern and for colorectal (0.71, 0.54-0.93) in the double peak pattern. Moreover, the mediating effects of inflammation were significant. CONCLUSION Optimal PA trajectories reduced cancer incidence, especially in double peak and vigorous patterns. The protective effect was associated with both intensity and circadian rhythm. Crucially, this protection was mediated by inflammation regulation.
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Affiliation(s)
- Pufei Bai
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China; Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin 300134, China
| | - Xiaoqun Ning
- Special Medical Service Center, Zhujiang Hospital, Southern Medical University, No. 253, Middle Industrial Avenue, Haizhu District, Guangzhou, Guangdong, China
| | - Rui Gao
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China; Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin 300134, China
| | - Xian Shao
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China; Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin 300134, China
| | - Saijun Zhou
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China; Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin 300134, China
| | - Jing Li
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China; Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin 300134, China
| | - Yao Lin
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China; Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin 300134, China
| | - Hongyan Liu
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China; Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin 300134, China
| | - Mianzhi Zhang
- Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078, People's Republic of China; Tianjin Academy of Traditional Chinese Medicine, Tianjin 300120, People's Republic of China.
| | - Pei Yu
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China; Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin 300134, China.
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Harhay MN, Kim Y, Moore K, Harhay MO, Katz R, Shlipak MG, Mattix-Kramer HJ. Modifiable kidney disease risk factors among nondiabetic adults with obesity from the Multi-Ethnic Study of Atherosclerosis. Obesity (Silver Spring) 2023; 31:3056-3065. [PMID: 37766596 DOI: 10.1002/oby.23883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE It is unknown whether weight change or physical fitness is associated with chronic kidney disease (CKD) risk among nondiabetic adults with obesity. METHODS This was a prospective, longitudinal cohort study of adults with obesity without baseline CKD or diabetes enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA). Linear mixed-effects and multistate models were adjusted for demographics, time-varying covariates including blood pressure, and comorbidities these were used to examine associations of weight change and slow walking pace (<2 miles/h) with (i) rate of annual estimated glomerular filtration rate (eGFR) decline and (ii) incident CKD, defined as eGFRCr-Cys < 60 mL/min/1.73 m2 , and tested for interaction by baseline hypertension status. RESULTS Among 1208 included MESA participants (median BMI 33.0 kg/m2 [interquartile range 31.2-35.9]), 15% developed CKD. Slow walking pace was associated with eGFR decline (-0.27 mL/min/1.73 m2 /year; 95% CI: -0.42 to -0.12) and CKD risk (adjusted hazard ratio 1.48; 95% CI: 1.08 to 2.01). Weight gain was associated with CKD risk (adjusted hazard ratio 1.34; 95% CI: 1.02 to 1.78 per 5 kg weight gain from baseline). There was no significant interaction by baseline hypertension status. CONCLUSIONS Slow walking pace and weight gain were associated with CKD risk among adults with obesity who did not have diabetes at baseline.
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Affiliation(s)
- Meera N Harhay
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
- Department of Medicine, Division of Nephrology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Yuna Kim
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Kari Moore
- Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Michael O Harhay
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, San Francisco VA Healthcare System and University of California, San Francisco, California, USA
| | - Holly J Mattix-Kramer
- Departments of Public Health Science and Medicine, Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, Illinois, USA
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11
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Sheshadri A, Lai M, Hsu FC, Bauer SR, Chen SH, Tse W, Jotwani V, Tranah GJ, Lai JC, Hallan S, Fielding RA, Liu C, Ix JH, Coca SG, Shlipak MG. Structured Moderate Exercise and Biomarkers of Kidney Health in Sedentary Older Adults: The Lifestyle Interventions and Independence for Elders Randomized Clinical Trial. Kidney Med 2023; 5:100721. [PMID: 37915963 PMCID: PMC10616412 DOI: 10.1016/j.xkme.2023.100721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Rationale & Objective In the Lifestyle Interventions and Independence for Elders (LIFE) trial, a structured exercise intervention slowed kidney function decline in sedentary older adults. Biomarkers of kidney health could distinguish potential mechanisms for this beneficial effect. Study Design Randomized controlled trial. Setting & Population A total of 1,381 sedentary adults aged 70-89 years enrolled in the LIFE trial. Intervention Structured, 2-year, moderate-intensity exercise intervention versus health education. Outcomes Physical activity was measured by step count. Primary outcomes were changes in 14 serum and urine biomarkers of kidney health collected at baseline, year 1, and year 2. We determined the effect of randomization on changes in kidney measures and then evaluated observational associations of achieved activity on each measure. Results Participants assigned to exercise walked on average 291 more steps per day than participants assigned to health education. The intervention was not significantly associated with changes in biomarkers of kidney health. In observational analyses, persons in the highest versus lowest quartile of activity (≥3,470 vs <1,568 steps/day) had significant improvement in urine albumin (mean, -0.22 mg albumin/g urine creatinine [interquartile range (IQR), -0.37 to -0.06]), alpha-1-microglobulin (-0.18 mg/L [-0.28 to -0.08]), trefoil factor-3 (-0.24 pg/mL [-0.35 to -0.13]), epidermal growth factor (0.19 pg/mL [0.06-0.32]), uromodulin (0.06 pg/mL [0.00-0.12]), interleukin 18 (-0.09 pg/mL [-0.15 to -0.03]), neutrophil gelatinase-associated lipocalin (-0.16 pg/mL [-0.24 to -0.07]), monocyte chemoattractant protein-1 (-0.25 pg/mL [-0.36 to -0.14]), clusterin (-0.16 pg/mL [-0.30 to -0.02]), serum tumor necrosis factor receptor-1 (-0.25 mg/dL [-0.39 to -0.11]) and tumor necrosis factor receptor-2 (-0.30 mg/dL [-0.44 to -0.16]). In sensitivity analyses, incremental changes in activity were most impactful on urine interleukin 18 and serum tumor necrosis factor-1. Limitations The original study was not designed to assess the impact on kidney health. Non-white individuals and patients with advanced chronic kidney disease are underrepresented. Conclusions Randomization to structured exercise did not improve kidney health at a group level. However, higher exercise was associated with concurrent improvements in biomarkers of glomerular injury, tubular function/repair, tubular injury, generalized inflammation, and tubulointerstitial repair/fibrosis. Plain-Language Summary In the Lifestyle Interventions For Elders (LIFE) study, randomization to an exercise and physical activity intervention improved the slope of estimated glomerular filtration rate over 2 years compared with health education among older adults. In this study, we sought to determine whether there were specific biomarkers of kidney health that were affected by the exercise and physical activity intervention to investigate potential mechanisms for this positive impact on kidney decline. We found that randomization to the intervention did not improve any of the 14 measures of kidney tubule health. However, in observational analyses, higher activity was independently associated with improvements in several domains, especially tubular injury and generalized inflammation. These results help to clarify the impact of physical activity on kidney health.
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Affiliation(s)
- Anoop Sheshadri
- Department of Medicine, University of California San Francisco, San Francisco, CA
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
| | - Mason Lai
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Scott R. Bauer
- Department of Medicine, University of California San Francisco, San Francisco, CA
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
| | - Shyh-Huei Chen
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Warren Tse
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
| | - Vasantha Jotwani
- Department of Medicine, University of California San Francisco, San Francisco, CA
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
| | | | - Jennifer C. Lai
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Stein Hallan
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roger A. Fielding
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Christine Liu
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
- Geriatric Research Education and Clinical Center, Palo Alto VA Health Care System, Palo Alto, CA
| | - Joachim H. Ix
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Steven G. Coca
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael G. Shlipak
- Department of Medicine, University of California San Francisco, San Francisco, CA
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
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12
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Molsted S, Bennett PN, Wilund K, Bruun K, Pakpour AH, Liljehult JM, Brandi L. Nurses' and medical doctors' attitudes towards exercise for people with chronic kidney disease in Denmark. J Ren Care 2023; 49:206-216. [PMID: 36274056 DOI: 10.1111/jorc.12445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Implementation of exercise training in people with kidney failure may be affected by clinicians' attitudes. OBJECTIVES To investigate Danish nephrology nurses' and medical doctors' attitudes towards: exercise for people undergoing dialysis; use of physical activity interventions in chronic kidney disease; and to compare Danish and previously reported Australian nurse attitudes. DESIGN Cross-sectional survey. PARTICIPANTS Nurses and medical doctors from the nephrology field in Denmark. MEASUREMENTS The questionnaire attitudes towards exercise in dialysis, and questions about exercise advice, counselling and interventions. RESULTS Nephrology nurses (n = 167) and 17 medical doctors (women 92%, age 47 ± 11 years) from 19 dialysis units participated. There were no differences between nurses' and medical doctors attitudes about training. Ninety-five % and 88% of nurses and medical doctors, respectively, agreed that most people undergoing dialysis could benefit from exercise. Exercise training was offered to people undergoing haemodialyses in 88% of 17 departments. Danish nurses reported more positive attitudes than Australian towards exercise (p < 0.05). Ninety-five % and 86% of the Danish and Australian nurses, respectively, agreed/strongly agreed that most people undergoing dialysis could benefit from exercise. Six % and 35% of the Danish and Australian nurses, respectively, agreed/strongly agreed that most people with dialysis were too sick to exercise. CONCLUSION Danish nephrology nurses and medical doctors had mostly positive attitudes to exercise training to people undergoing dialysis, and exercise to people with dialysis was offered frequently. Danish and Australian nurses had positive attitudes to exercise to people undergoing dialysis, it was however more positive in Danish nurses.
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Affiliation(s)
- Stig Molsted
- Department of Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Paul N Bennett
- Medical & Clinical Affairs, Satellite Healthcare, San Jose, California, USA
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Ken Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Karina Bruun
- The Department of Nephrology, Rigshospitalet, Copenhagen, Denmark
| | - Amir H Pakpour
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | | | - Lisbet Brandi
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Hillerød, Denmark
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13
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Ray N, Reddy PH. Structural and physiological changes of the kidney with age and its impact on chronic conditions and COVID-19. Ageing Res Rev 2023; 88:101932. [PMID: 37031725 PMCID: PMC10081878 DOI: 10.1016/j.arr.2023.101932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/11/2023]
Abstract
The kidney is an essential organ that removes waste products, balances the body's fluids, releases hormones that regulate blood pressure, produces an active form of vitamin D, promotes healthy bones, and controls the production of red blood cells. Structural and functional abnormalities occur in kidney with age. Alterations in kidney structure are based on physiological functions and environmental pressures. Variations in its structure across vertebrates are primarily due to the nature of alterations in number, complexity, arrangement, and location of the kidney tubules. Globally, individuals aged 65 and older are part of the fastest expanding population demographic, and as a result, a greater number of older patients are receiving a diagnosis of impaired renal function. The purpose of our mini-review is to summarize recent findings of the structural and functional differences between the normal and aging kidney, examine the evolutionary biology of the kidney across species, and demonstrate the role of aging in conditions such as diabetes, chronic kidney disease, and hypertension, along with their impact on SARS-CoV-2. Additional aims include discussing the potential therapeutic strategies to treat aged individuals with kidney health issues and how the impact of a healthy lifestyle, diet, and exercise can improve health conditions with aged kidneys.
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Affiliation(s)
- Nandini Ray
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Public Health, School of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Speech, Language, and Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Nutritional Sciences, School of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA.
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14
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Simões E Silva AC, Oliveira EA, Cheung WW, Mak RH. Redox Signaling in Chronic Kidney Disease-Associated Cachexia. Antioxidants (Basel) 2023; 12:antiox12040945. [PMID: 37107320 PMCID: PMC10136196 DOI: 10.3390/antiox12040945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/14/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Redox signaling alterations contribute to chronic kidney disease (CKD)-associated cachexia. This review aims to summarize studies about redox pathophysiology in CKD-associated cachexia and muscle wasting and to discuss potential therapeutic approaches based on antioxidant and anti-inflammatory molecules to restore redox homeostasis. Enzymatic and non-enzymatic systems of antioxidant molecules have been studied in experimental models of kidney diseases and patients with CKD. Oxidative stress is increased by several factors present in CKD, including uremic toxins, inflammation, and metabolic and hormone alterations, leading to muscle wasting. Rehabilitative nutritional and physical exercises have shown beneficial effects for CKD-associated cachexia. Anti-inflammatory molecules have also been tested in experimental models of CKD. The importance of oxidative stress has been shown by experimental studies in which antioxidant therapies ameliorated CKD and its associated complications in the 5/6 nephrectomy model. Treatment of CKD-associated cachexia is a challenge and further studies are necessary to investigate potential therapies involving antioxidant therapy.
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Affiliation(s)
- Ana Cristina Simões E Silva
- Department of Pediatrics, Division of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte 30130-100, MG, Brazil
| | - Eduardo A Oliveira
- Department of Pediatrics, Division of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte 30130-100, MG, Brazil
| | - Wai W Cheung
- Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego, La Jolla, CA 92093, USA
| | - Robert H Mak
- Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego, La Jolla, CA 92093, USA
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15
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Kunutsor SK, Isiozor NM, Myers J, Seidu S, Khunti K, Laukkanen JA. Baseline and usual cardiorespiratory fitness and the risk of chronic kidney disease: A prospective study and meta-analysis of published observational cohort studies. GeroScience 2023:10.1007/s11357-023-00727-3. [PMID: 36646903 PMCID: PMC10400499 DOI: 10.1007/s11357-023-00727-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
Chronic kidney disease (CKD) is a global public health burden but is largely preventable. Few studies have reported an association between high levels of cardiorespiratory fitness (CRF) and decreased risk of CKD. However, some relevant aspects of the association, such as the dose-response relationship and the long-term relevance of CRF levels to CKD, have yet to be addressed. We, therefore, aimed to quantify the nature and magnitude of the association between CRF and CKD in a cohort of 2099 men aged 42-61 years with normal kidney function at baseline. CRF was directly measured using a respiratory gas exchange analyzer during cardiopulmonary exercise testing. Hazard ratios (HRs) (95% CIs) were estimated for the incidence of CKD. Correction for within-person variability was made using data from repeat measurements of CRF taken 11 years after baseline. A total of 197 CKD events were recorded during a median follow-up of 25.8 years. The age-adjusted regression dilution ratio for CRF was 0.59 (95% CI: 0.53-0.65). The risk of CKD decreased in a graded fashion with increasing CRF. Comparing extreme tertiles of CRF, the HR (95% CI) for CKD was 0.67 (0.46-0.97) following adjustment for several established and emerging risk factors. The corresponding adjusted HR (95% CI) was 0.51 (0.27-0.96) following correction for within-person variability. In a meta-analysis of five population-based cohort studies (including the current study) comprising 32,447 participants and 4,043 CKD cases, the fully-adjusted risk ratios (95% CIs) for CKD comparing extreme tertiles of baseline and long-term CRF values were 0.58 (0.46-0.73) and 0.40 (0.27-0.59), respectively. Findings from a new prospective study and pooled analysis of previous studies plus the new study indicate that high CRF levels are strongly and independently associated with a reduced risk of CKD and consistent with a linear dose-response relationship. Using single baseline measurements of CRF to investigate the association between CRF and CKD risk could considerably underestimate the true association.
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Affiliation(s)
- Setor K Kunutsor
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4WP, UK.
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK.
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Nzechukwu M Isiozor
- Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Healthcare System and Stanford University, Palo Alto, CA, USA
| | - Samuel Seidu
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK
| | - Kamlesh Khunti
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK
| | - Jari A Laukkanen
- Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland
- Central Finland Health Care District Hospital District, Department of Medicine,Jyväskylä, Finland District, Jyväskylä, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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16
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Sato T, Morishita S, Ono M, Funami Y, Hayao K, Kusano D, Kohzuki M. Peak exercise oxygen uptake and changes in renal function in patients after acute myocardial infarction. Heart Lung 2023; 57:277-282. [PMID: 36332352 DOI: 10.1016/j.hrtlng.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of exercise tolerance on renal function change after acute myocardial infarction (AMI) is not clear. OBJECTIVES The present study aimed to elucidate the effect of peak exercise oxygen uptake (VO2) levels on longitudinal changes in renal function up to 1 year after onset of AMI. METHODS This retrospective longitudinal study enrolled 198 AMI patients. Symptom-limited cardiopulmonary exercise testing was performed at completion of early Phase II cardiac rehabilitation, and peak VO2 levels were defined as the primary exposure factor. The estimated glomerular filtration rates (eGFRs) at baseline, 3 months, 6 months and 1 year were collected. Generalized estimating equation (GEE) models were used to test the longitudinal effect of peak VO2 levels on within-patient changes in eGFR. RESULTS Patients were stratified into tertile groups (Low group, 12.3 ± 1.3 mL/kg/min; Mid group, 15.3 ± 0.7 mL/kg/min; and High group, 19.1 ± 2.3 mL/kg/min) according to peak VO2 levels. The slopes of eGFR over 1 year in the Low (p = 0.024) and Mid groups (p = 0.037) were lower compared to the High group. The Low group had a significantly higher odds ratio of experiencing rapid renal function decline than the High group (odds ratio, 2.87; p = 0.012). CONCLUSIONS There was a significant effect of lower peak VO2 on rapid decline in renal function after AMI. Our findings suggest that the coexistence of exercise intolerance may be a novel risk factor for rapid decline in renal function after AMI.
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Affiliation(s)
- Toshimi Sato
- Department of Rehabilitation, Southern Tohoku General Hospital, Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama, Fukushima 963-8563, Japan.
| | - Shinichiro Morishita
- Department of Physical Therapy, Fukushima Medical University School of Health Sciences, Fukushima, Japan
| | - Masahiro Ono
- Department of Cardiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Yoshinari Funami
- Department of Rehabilitation, Southern Tohoku General Hospital, Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama, Fukushima 963-8563, Japan
| | - Keishi Hayao
- Department of Rehabilitation, Southern Tohoku General Hospital, Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama, Fukushima 963-8563, Japan
| | - Daichi Kusano
- Department of Rehabilitation, Southern Tohoku General Hospital, Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama, Fukushima 963-8563, Japan
| | - Masahiro Kohzuki
- Yamagata Prefectural University of Health Sciences, Yamagata, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan
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17
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Home-Based Exercise in Elderly Patients with Claudication and Chronic Kidney Disease Is Associated with Lower Progressive Renal Function Worsening: A 5-Year Retrospective Study. Metabolites 2022; 13:metabo13010056. [PMID: 36676981 PMCID: PMC9862132 DOI: 10.3390/metabo13010056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
This observational study aimed to monitor the 5-year trends of kidney function in patients with peripheral artery disease (PAD) and concomitant chronic kidney disease (CKD) enrolled or not enrolled into a rehabilitative exercise program. Sixty-six patients (aged 72 ± 10, males n = 52) at KDOQI stages III-IV and PAD at Rutherford's stage I-III were included in the study, with a group (Exercise, EX; n = 32) receiving a 6-month structured pain-free home-based walking program and a group (Control, CO; n = 34) receiving walking advice and optimal nephrological care. Outcomes included kidney function measured through serum creatinine (sCr) and clinical outcomes, including the rate of advance of CKD stages and admission to dialysis, revascularizations, and hospitalizations. At baseline, the two groups were comparable for age, nephropathy, medications, comorbidities, and PAD severity. Patients in the EX group safely completed the exercise program. SCr values were slightly increased in EX (baseline: 2.35 ± 0.32; 5-year: 2.71 ± 0.39 mg/dL) and progressively worsened in CO (baseline: 2.30 ± 0.31; 5-year 4.22 ± 0.42 mg/dL), with a significant between-group difference (p = 0.002). The control group also showed a higher number of dialysis admissions (5 vs. 0, p = 0.025) and advancing CKD stage as well a higher risks for lower limb revascularization (hazard ratio: 2.59; 95%CI: 1.11-6.02; p = 0.027) and for all-cause hospitalization (hazard ratio: 1.77; 95%CI: 1.05-2.97; p = 0.031). PAD-CKD patients enrolled in a low-moderate intensity home-exercise program showed more favorable long-term trends in kidney function and clinical outcomes than patients with usual care. These preliminary observations need to be confirmed in randomized trials.
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18
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Scrutinio D, Guida P, Dalla Vecchia LA, Corrà U, Passantino A. Cardiac Rehabilitation for Older Women with Heart Failure. J Pers Med 2022; 12:jpm12121980. [PMID: 36556201 PMCID: PMC9785443 DOI: 10.3390/jpm12121980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background: the role that sex plays in impacting cardiac rehabilitation (CR) outcomes remains an important gap in knowledge. Methods: we assessed sex differences in clinical and functional outcomes in 2345 older patients with heart failure (HF) admitted to inpatient CR. Three outcomes were considered: (1) the composite outcome of death during the index admission to CR or transfer to acute care; (2) three-year mortality; (3) change in six-minute walking distance (6MWD) from admission to discharge. Sex differences in outcomes were assessed using multivariable Cox or logistic regression models. Results: the hazard ratios of the composite outcome and of three-year mortality for females vs. males were 0.71 (95%CI:0.50−1.00; p = 0.049) and 0.68 (95%CI:0.59−0.79; p < 0.001), respectively. The standardized mean difference in 6MWD increase from admission to discharge between males and females was 0.10. The odds ratio of achieving an increase in 6MWD at discharge to values higher than the optimal sex-specific thresholds for predicting mortality for females vs. males was 2.21 (95%CI:1.53−3.20; p < 0.001). Conclusion: our findings suggest that older females with HF undergoing CR have better prognosis and garner similar improvement in 6MWD compared with their male counterparts. Nonetheless, females were more likely to achieve levels of functional capacity predictive of improved survival.
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Affiliation(s)
- Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, 70100 Bari, Italy
- Correspondence:
| | - Pietro Guida
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, 70100 Bari, Italy
| | | | - Ugo Corrà
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Veruno, 28010 Veruno, Italy
| | - Andrea Passantino
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, 70100 Bari, Italy
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Okamura M, Inoue T, Ogawa M, Shirado K, Shirai N, Yagi T, Momosaki R, Kokura Y. Rehabilitation Nutrition in Patients with Chronic Kidney Disease and Cachexia. Nutrients 2022; 14:nu14224722. [PMID: 36432408 PMCID: PMC9696968 DOI: 10.3390/nu14224722] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
Rehabilitation nutrition is a proposed intervention strategy to improve nutritional status and physical function. However, rehabilitation nutrition in patients with cachexia and protein-energy wasting (PEW), which are the main nutrition-related problems in patients with chronic kidney disease (CKD), has not been fully clarified. Therefore, this review aimed to summarize the current evidence and interventions related to rehabilitation nutrition for cachexia and PEW in patients with CKD. CKD is a serious condition worldwide, with a significant impact on patient prognosis. In addition, CKD is easily complicated by nutrition-related problems such as cachexia and PEW owing to disease background- and treatment-related factors, which can further worsen the prognosis. Although nutritional management and exercise therapy are reportedly effective for cachexia and PEW, the effectiveness of combined nutrition and exercise interventions is less clear. In the future, rehabilitation nutrition addressing the nutritional problems associated with CKD will become more widespread as more scientific evidence accumulates. In clinical practice, early intervention in patients with CKD involving both nutrition and exercise after appropriate assessment may be necessary to improve patient outcomes.
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Affiliation(s)
- Masatsugu Okamura
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany
- Department of Rehabilitation Medicine, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
- Change Nutrition from Rehabilitation–Virtual Laboratory (CNR), Niigata 950-3198, Japan
| | - Tatsuro Inoue
- Change Nutrition from Rehabilitation–Virtual Laboratory (CNR), Niigata 950-3198, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Masato Ogawa
- Change Nutrition from Rehabilitation–Virtual Laboratory (CNR), Niigata 950-3198, Japan
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe 650-0017, Japan
| | - Kengo Shirado
- Change Nutrition from Rehabilitation–Virtual Laboratory (CNR), Niigata 950-3198, Japan
- Department of Rehabilitation, Aso Iizuka Hospital, Fukuoka 820-8505, Japan
| | - Nobuyuki Shirai
- Change Nutrition from Rehabilitation–Virtual Laboratory (CNR), Niigata 950-3198, Japan
- Department of Rehabilitation, Niigata Rinko Hospital, Niigata 950-8725, Japan
| | - Takuma Yagi
- Change Nutrition from Rehabilitation–Virtual Laboratory (CNR), Niigata 950-3198, Japan
- Department of Rehabilitation, Hattori Hospital, Miki 673-0413, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Yoji Kokura
- Department of Nutritional Management, Keiju Hatogaoka Integrated Facility for Medical and Long-Term Care, Hoso 927-0023, Japan
- Correspondence: ; Tel.: +81-768-52-3335
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20
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Seliger S, Weiner DE. Exercise and Kidney Disease Prevention: Walk This Way. Am J Kidney Dis 2022; 80:552-554. [PMID: 35872228 DOI: 10.1053/j.ajkd.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/04/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Stephen Seliger
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Daniel E Weiner
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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