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Liu C, Yang J, Li H, Deng Y, He P, Zhang J, Chen S, Chen S, Wang X, Zhang M. Comparative efficacy of exercise modalities for general risk factors, renal function, and physical function in non-dialysis chronic kidney disease patients: a systematic review and network meta-analysis. Ren Fail 2024; 46:2373272. [PMID: 38967189 PMCID: PMC467113 DOI: 10.1080/0886022x.2024.2373272] [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: 03/29/2024] [Accepted: 06/22/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Exercise therapy can effectively manage chronic kidney disease (CKD) risk factors and improve renal function and physical fitness, but the challenge lies in choosing the right exercise type tailored to patients' condition. METHODS An electronic search of databases including PubMed, The Cochrane Library, EMBASE, Web of Science, VIP, WanFang, and CNKI was performed. The random effects model was used. Mean difference was employed as the effect size for continuous variables, with 95% confidence interval (CI) provided. RESULTS A total of 36 RCTs were included in this study. Compared to conventional therapy (CT), the combination of three exercise therapies with CT resulted in notable benefits in enhancing six minutes walk test (6MWT) capacity, 24-h urinary protein quantity (24hUTP), systolic blood pressure (SBP), diastolic blood pressure (DBP). Resistance exercise therapy (RT) + CT were more effective than CT to reduce serum creatinine (Scr), body mass index (BMI), and hemoglobin A1c (HbA1c) and improve estimated glomerular filtration rate (eGFR). In terms of improving peak oxygen uptake (VO2 peak), only two exercise modalities were involved, aerobic exercise therapy (AT) and combined (Resistance-Aerobic) exercise therapy (CBT), both of which were more efficacious than CT. The efficacy ranking overall demonstrated clear benefits for RT in enhancing eGFR and 6MWT, decreasing Scr, BMI, SBP, DBP, and HbA1c, while AT was more suitable for boosting VO2 peak, and CBT had greater potential for reducing 24hUTP. CONSLUSIONS Exercise therapy combined with CT offers significant advantages over CT in many cases, but no single exercise modality is universally effective for all indicators.
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Affiliation(s)
- Cong Liu
- Department of Nephrology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Jiju Yang
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Hongdian Li
- Department of Nephrology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yuanyuan Deng
- Department of Nephrology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Pengfei He
- Department of Nephrology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Jiao Zhang
- Department of Nephrology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Shu Chen
- Department of Nephrology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Siyu Chen
- Department of Nephrology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Xinli Wang
- Department of Nephrology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Mianzhi Zhang
- Department of Nephrology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
- Department of Nephrology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
- Tianjin Famous Chinese Medicine Inheritance Workshop of Mianzhi Zhang, Tianjin, China
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Wang J, Xiao X, Zhang H, Wu D, Luo F, Yu J. Effects of additional physical exercise on the nutritional status and disease progression during the low-protein diet in Chronic Kidney Disease Patients: a systematic review and meta-analysis. Eur J Clin Nutr 2024:10.1038/s41430-024-01466-0. [PMID: 38961262 DOI: 10.1038/s41430-024-01466-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 07/05/2024]
Abstract
Low-protein diet (LPD) is the core of dietary and nutritional therapy for non-dialysis chronic kidney disease (CKD) patients. In addition, physical exercise could prevent and treat various illnesses and chronic diseases. The objective of the study was to search for and appraise evidence on the effect of additional physical exercise on patients' nutritional status and indicators of disease progression when compared with the LPD alone. PubMed Central, Embase, Cochrane, and Web of Knowledge for randomized controlled trials (published between January 1, 1956 and May 17, 2023) were searched. A total of 8698 identified studies, 9 were eligible and were included in our analysis (N = 250 participants). Compared with the LPD alone, additional physical exercise reduced serum creatinine by a mean of -0.21 mg/dL (95% CI -0.39 to -0.03) in CKD patients. Similarly, blood pressure decreased after physical exercise, with systolic blood pressure decreasing by -7.05 mm Hg (95% CI -13.13 to -0.96) and diastolic blood pressure decreasing by -5.31 mm Hg (95% CI -7.99 to -2.62). Subgroup analyses revealed that resistance exercise (RE) was effective in decreasing estimated glomerular filtration rate (eGFR) of -1.71 mL/min per 1.73 m² (95% CI -3.29 to -0.14). In addition, the VO2peak increasing by 2.41 mL/kg/min (95% CI 0.13 to 4.70) when physical exercise was continued for 24 weeks. The above results suggest that the LPD with additional physical exercise care is more beneficial for patients with CKD.
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Affiliation(s)
- Jing Wang
- Department of Nutrition, Fifth Hospital in Wuhan, Wuhan, China
| | - Xiaofen Xiao
- Department of Nutrition, Fifth Hospital in Wuhan, Wuhan, China
| | - Hui Zhang
- Department of Orthopaedics, Fifth Hospital in Wuhan, Wuhan, China
| | - Dan Wu
- Department of Orthopaedics, Fifth Hospital in Wuhan, Wuhan, China
| | - Feifei Luo
- Department of Cardiac Function, Fourth Hospital in Wuhan, Wuhan, China
| | - Juling Yu
- Department of Infection Management, Fifth Hospital in Wuhan, Wuhan, China.
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Zang W, Fang M, Xiao N, Zhang X, Lin C, Wang S. Quantifying the dose-response relationship between exercise and health-related quality of life in patients undergoing haemodialysis: A meta-analysis. Prev Med Rep 2024; 42:102737. [PMID: 38707251 PMCID: PMC11066687 DOI: 10.1016/j.pmedr.2024.102737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024] Open
Abstract
Objective This meta-analysis aims to explore the dose-response relationship of aerobic exercise or aerobic combined resistance exercise on cardiopulmonary function in maintenance hemodialysis(MHD), with the goal of aiding in the formulation of precise exercise prescriptions. Methods A literature search up to August 18, 2023, was conducted in databases including Web of Science, among others, focusing on the effects of exercise interventions on cardiopulmonary function in hemodialysis patients.Two researchers independently conducted literature screening, data extraction, and an assessment of study methodology quality. A dose-response meta-analysis was carried out using a one-stage cubic spline mixed-effects model, followed by stratified analyses based on intervention period, intervention method, and exercise environment. Results A nonlinear dose-response relationship was observed between exercise and 6-minute walk test (6WMT) as well as peak oxygen uptake (VO2Peak) in hemodialysis patients. The optimal exercise dose for the 6WMT across the full exposure range was 922 METs-min/week, with VO2Peak increasing with the dose. The effects were influenced by the type of exercise, intervention period, and exercise environment. An exercise dose of 500 METs-min/week and 619 METs-min/week was found sufficient to achieve the minimal clinically important differences (MCID) for 6WMT and VO2Peak, respectively. Conclusion There is a significant association between the dose of exercise and its effects. With appropriate adjustment of variables, even low-dose exercise can lead to clinically significant improvements in cardiopulmonary function.
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Affiliation(s)
- Wanli Zang
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Mingqing Fang
- Xiangya Hospital, Central South University, Changsha, China
| | - Ningkun Xiao
- Department of Immunochemistry, Institution of Chemical Engineering, Ural Federal University, Russia
| | - Xianzuo Zhang
- Department of Orthopedics, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Changchun Lin
- Xiangya Hospital, Central South University, Changsha, China
| | - Su Wang
- Department of Sports Science, University of Harbin Sport, Harbin, China
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4
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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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Kohzuki M. Renal Rehabilitation: Present and Future Perspectives. J Clin Med 2024; 13:552. [PMID: 38256684 PMCID: PMC10816861 DOI: 10.3390/jcm13020552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Chronic kidney disease (CKD) is a global health problem. In patients with CKD, exercise endurance is decreased, especially as renal dysfunction advances. This is due to the combined effects of protein-energy wasting, uremic acidosis, and inflammatory cachexia, which lead to sarcopenia and are aggravated by a sedentary lifestyle, resulting in a progressive downward spiral of deconditioning. Renal rehabilitation (RR) is a coordinated, multifaceted intervention designed to optimize a patient's physical, psychological, and social functioning, as well as to stabilize, slow, or even reverse the progression of renal deterioration, improving exercise tolerance and preventing the onset and worsening of heart failure, thereby reducing morbidity and mortality. This review focused on the history and benefits of RR in patients with CKD. Based on current evidence, RR is an effective, feasible, and safe secondary prevention strategy in CKD. RR is a promising model for a new field of rehabilitation. Therefore, efforts to increase RR implementation rates are urgently needed.
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Affiliation(s)
- Masahiro Kohzuki
- President and Chairman, Department of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata 990-2212, Japan; ; Tel./Fax: +81-23-686-6601
- Professor Emeritus, Department of Health Sciences, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
- Chairman of the Board of Directors, International Society of Renal Rehabilitation, Sendai 980-8575, Japan
- Former Chairman of the Board of Directors, Japanese Society of Renal Rehabilitation; Tokyo 150-0043, Japan
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Lin M, Wu S, Deng X, Chen Y, Tan X. Visceral fat and its dynamic change are associated with renal damage: Evidence from two cohorts. Clin Exp Hypertens 2023; 45:2271187. [PMID: 37871163 DOI: 10.1080/10641963.2023.2271187] [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: 07/12/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND AND AIMS To evaluate the association of Chinese visceral adiposity index (CVAI) and its dynamic trends with risk of renal damage, and to compare its prediction performance with that of other obesity indices. METHODS AND RESULTS A community-based population with 23 905 participants from Shantou city was included in the cross-sectional analysis. A total of 9,778 individuals from two separated cohort were included in the longitudinal portion. Five patterns of CVAI change were predefined (low-stable, decreasing, moderate, increasing, and persistent-high). Logistic and Cox regressions were used to evaluate the association between CVAI and renal damage. We explored potential mechanisms using the mediating effect method, and the prediction performance was determined by receiver operating characteristic curve analysis. Results from both cross-sectional and longitudinal data revealed a positive and linear association between CVAI and risk of renal damage. Pooled analysis of the two cohorts showed that per unit increase in Z score of CVAI induced 18% increased risk of renal damage (P = .008). Longitudinal trends of CVAI were also associated with renal damage, and the moderate, increasing, and persistent-high patterns showing a higher risk. Blood pressure and glucose had a mediating effect on renal damage induced by CVAI. Among several obesity indices, CVAI was the optimal for predicting renal damage. CONCLUSION A higher level of immediate CVAI and longitudinal increasing and persistent-high patterns of CVAI were independently associated with increased risk of renal damage. Monitoring immediate level and long-term trend of CVAI may contribute to the prevention of renal damage.
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Affiliation(s)
- Mengyue Lin
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shiwan Wu
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xiulian Deng
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yequn Chen
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Clinical Research Center, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xuerui Tan
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Clinical Research Center, First Affiliated Hospital of Shantou University Medical College, Shantou, China
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Ohata T, Kishikawa H, Tamaki A, Matsuzawa R, Katsuno T, Miyamoto T. Relationship Between Physical Activity and Estimated Glomerular Filtration Rate in Renal Transplant Recipients: A Cross-sectional Study Analyzing Isotemporal Substitution Model. J Ren Nutr 2023; 33:755-763. [PMID: 37302717 DOI: 10.1053/j.jrn.2023.05.008] [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: 04/17/2022] [Revised: 05/17/2023] [Accepted: 05/27/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVES Successful renal transplantation reduces mortality rates. However, the decline in the estimated glomerular filtration rate (eGFR) after transplantation is strongly associated with premature mortality in renal transplant recipients (RTRs). Physical activity (PA) is a modifiable lifestyle factor with the potential to maintain or improve eGFR. However, the effects of the type or intensity of PA and sedentary behavior (SB) on eGFR in RTRs remain unclear. The purpose of this study was to clarify the association between accelerometry-measured PA and SB and eGFR in RTRs using isotemporal substitution (IS) analysis. METHODS A total of 82 renal transplant outpatients participated in this cross-sectional study, of which 65 (average age, 56.9 years; average time post-transplant, 83.0 months) were finally analyzed. All RTRs wore a triaxial accelerometer to measure PA for 7 consecutive days. The measured PA was classified based on intensity into light PA, moderate-to-vigorous PA (MVPA), and SB. The association of each type of PA with eGFR was examined using multi-regression analyses of single-factor, partition, and IS models. The IS model was applied to examine the estimated effects of substituting 30 minutes of SB with an equal amount of time of light PA or MVPA on eGFR. RESULTS The partition model showed that MVPA was an independent explanatory variable for eGFR (β = 5.503; P < .05), and the IS model identified that the substitution of time spent in SB with MVPA led to improvements in eGFR (β = 5.902; P < .05). CONCLUSIONS The present study suggests that MVPA has an independent and positive association with eGFR, and replacing 30 minutes of SB with MVPA after renal transplantation might lead to the maintenance or improvement of eGFR in RTRs.
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Affiliation(s)
- Takuya Ohata
- Department of Rehabilitation, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan
| | - Hidefumi Kishikawa
- Department of Urology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan
| | - Akira Tamaki
- School of Rehabilitation, Hyogo Medical University, Kobe, Hyogo, Japan
| | - Ryota Matsuzawa
- School of Rehabilitation, Hyogo Medical University, Kobe, Hyogo, Japan
| | - Tomoyuki Katsuno
- School of Rehabilitation, Hyogo Medical University, Kobe, Hyogo, Japan
| | - Toshiaki Miyamoto
- Faculty of Rehabilitation, Kansai Medical University, Hirakata, Osaka, Japan.
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Febles RM, Miranda DM, Perera CDLCC, Martín LD, Rodríguez-Rodríguez AE, González Martín AR, Sánchez Báez DJ, Porrini E. Therapeutic Exercise on Metabolic and Renal Outcomes in Patients with Chronic Kidney Disease: A Narrative Review. Nephron Clin Pract 2023; 148:85-94. [PMID: 37611542 DOI: 10.1159/000531921] [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: 01/25/2023] [Accepted: 06/28/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) affects 11-13% of the world population. The main risk factors for CKD include diabetes, hypertension, and obesity. Metabolic syndrome (MS) is associated with the onset of CKD in the nondiabetic population. Obesity and MS are also risk factors for a worse progression of established CKD. Therapeutic exercise is an effective option to treat and manage obesity, MS, and diabetes in the general population. However, the evidence on the effect of exercise on patients with CKD, obesity, and MS is scarce. SUMMARY We evaluated available evidence on the effect of therapeutic exercise in patients with CKD, excluding dialysis, particularly in improving the metabolic risk factors and main renal outcomes: renal function loss and albuminuria/proteinuria. This review includes prospective studies and clinical trials. A total of 44 studies were analysed in 1,700 subjects with renal disease (2-5), including patients with renal transplantation. Most studies did not prove a major effect of exercise on albuminuria/proteinuria, glomerular filtration rate (GFR), obesity, or MS. These results are intriguing and deserve attention. The exploratory nature of most studies, including a low number of cases and short follow-up, might explain the lack of efficacy of exercise in our analysis. Specific aspects like the type of exercise, frequency, intensity, duration, accommodation during follow-up, individualization, safety, and adherence are crucial to the success of therapeutic exercise. The beneficial role of exercise in patients with CKD remains to be determined. KEY MESSAGES Key messages of this review are as follows. (1) The effect of therapeutic exercise on renal and metabolic outcomes in patients with CKD remains to be determined. (2) According to the evidence selected, therapeutic exercise seems to be safe to treat patients with CKD. (3) Most studies are exploratory by nature, with results that need further investigation. (4) Therapeutic exercise is a complex procedure that must be specifically designed to treat patients with CKD.
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Affiliation(s)
- Raúl Morales Febles
- Faculty of Medicine, University of La Laguna, Tenerife, Spain,
- Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, Tenerife, Spain,
| | - Domingo Marrero Miranda
- Instituto de Tecnologías Biomédicas (ITB), Faculty of Medicine, University of La Laguna, Tenerife, Spain
| | - Coriolano de la Concepción Cruz Perera
- Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, Tenerife, Spain
- Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna, Spain
| | - Laura Díaz Martín
- Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, Tenerife, Spain
| | | | | | | | - Esteban Porrini
- Faculty of Medicine, University of La Laguna, Tenerife, Spain
- Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna, Spain
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Neale EP, Rosario VD, Probst Y, Beck E, Tran TB, Lambert K. Lifestyle Interventions, Kidney Disease Progression, and Quality of Life: A Systematic Review and Meta-analysis. Kidney Med 2023; 5:100643. [PMID: 37235039 PMCID: PMC10205767 DOI: 10.1016/j.xkme.2023.100643] [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] [Indexed: 05/28/2023] Open
Abstract
Rationale & Objective Poor dietary patterns and low physical activity levels are important lifestyle-related factors that contribute to negative health outcomes in individuals with chronic kidney disease (CKD). Previous systematic reviews have not explicitly focused on these lifestyle factors, nor undertaken meta-analyses of any effects. We aimed to evaluate the effect of lifestyle interventions (such as diet, exercise, and other lifestyle-related interventions) on the risk factors for and progression of CKD and the quality of life. Study Design Systematic review and meta-analysis. Setting & Study Populations Individuals aged 16 years or older with CKD stages 1 to 5 not requiring kidney replacement therapy. Selection Criteria for Studies Randomized controlled trials of interventions. Data Extraction Kidney function, albuminuria, creatinine, systolic blood pressure, diastolic blood pressure, body weight, glucose control, and quality of life. Analytical Approach A random-effects meta-analysis with evidence certainty assessed using GRADE. Results Seventy-eight records describing 68 studies were included. Twenty-four studies (35%) were dietary interventions, 23 (34%) exercise, 9 (13%) behavioral, 1 (2%) hydration, and 11 (16%) multiple component. Lifestyle interventions resulted in significant improvements in creatinine (weighted mean difference [WMD], -0.43 mg/dL; 95% CI, -0.74 to -0.11; P = 0.008); 24-hour albuminuria (WMD, -53 mg/24 h; 95% CI, -56 to -50; P < 0.001); systolic blood pressure (WMD, -4.5 mm Hg; 95% CI, -6.7 to -2.4; P < 0.001); diastolic blood pressure (WMD, -2.2 mm Hg; 95% CI, -3.7 to -0.8; P = 0.003); and body weight (WMD, -1.1 kg; 95% CI, -2.0 to -0.1; P = 0.025). Lifestyle interventions did not result in significant changes in the estimated glomerular filtration rate (0.9 mL/min/1.73 m2; 95% CI, -0.6 to 2.3; P = 0.251). However, narrative synthesis indicated that lifestyle intervention resulted in improvements in the quality of life. Limitations Certainty of the evidence was rated very low for most outcomes, primarily owing to the risk of bias and inconsistency. No meta-analysis was possible for quality-of-life outcomes because of variations in measurement tools. Conclusions Lifestyle interventions seem to positively affect some risk factors for progression of CKD and quality of life.
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Affiliation(s)
| | | | | | | | | | - Kelly Lambert
- Address for Correspondence: Kelly Lambert, PhD, School of Medical, Indigenous and Health Science, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia.
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10
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Jeong HY, An HJ, Sung MJ, Ha MH, Lee YH, Yang DH, Yang TY, Han D, Lee SY. Proteomic profiling of protein expression changes after 3 months-exercise in ESRD patients on hemodialysis. BMC Nephrol 2023; 24:102. [PMID: 37085769 PMCID: PMC10122383 DOI: 10.1186/s12882-023-03146-w] [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: 12/14/2022] [Accepted: 03/31/2023] [Indexed: 04/23/2023] Open
Abstract
The prevalence of chronic kidney disease (CKD) is steadily increasing, and it is a global health burden. Exercise has been suggested to improve physical activity and the quality of life in patients with CKD, eventually reducing mortality. This study investigated the change in physical performance after exercise in dialysis-dependent patients with CKD and analyzed differentially expressed proteins before and after the exercise. Plasma samples were collected at enrollment and after 3 months of exercise. Liquid chromatography with tandem mass spectrometry analysis and data-independent acquisition results were analyzed to determine the significantly regulated proteins. A total of 37 patients on dialysis were recruited, and 16 were randomized to exercise for 3 months. The hand grip strength and the walking speed significantly improved in the exercise group. Proteome analysis revealed 60 significantly expressed proteins after 3 months of exercise. In the protein functional analysis, the significantly expressed proteins were involved in the immune response. Also, some of the key significantly expressed proteins [(M Matrix metallopeptidase 9 (MMP-9), Activin A Receptor Type 1B (ACVR1B), Fetuin B (FETUB)] were validated via an enzyme-linked immunosorbent assay. Our results showed that exercise in dialysis-dependent patients with CKD could improve their physical performance. These results indicated that this beneficial effect of exercise in these populations could be associated with immune response.
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Affiliation(s)
- Hye Yun Jeong
- Division of Nephrology, Department of Internal Medicine, CHA University School of Medicine, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam-si, 13496, Republic of Korea
| | - Hyun-Ju An
- Division of Nephrology, Department of Internal Medicine, CHA University School of Medicine, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam-si, 13496, Republic of Korea
| | - Min Ji Sung
- Division of Nephrology, Department of Internal Medicine, CHA University School of Medicine, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam-si, 13496, Republic of Korea
| | - Min Heui Ha
- Division of Nephrology, Department of Internal Medicine, CHA University School of Medicine, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam-si, 13496, Republic of Korea
| | - Yu Ho Lee
- Division of Nephrology, Department of Internal Medicine, CHA University School of Medicine, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam-si, 13496, Republic of Korea
| | - Dong Ho Yang
- Division of Nephrology, Department of Internal Medicine, CHA University School of Medicine, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam-si, 13496, Republic of Korea
| | - Tae Young Yang
- Division of Nephrology, Department of Internal Medicine, CHA University School of Medicine, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam-si, 13496, Republic of Korea
| | - Dohyun Han
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, 101 Daehak-ro, Seoul, 03080, Republic of Korea.
- Proteomics Core Facility, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
| | - So-Young Lee
- Division of Nephrology, Department of Internal Medicine, CHA University School of Medicine, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam-si, 13496, Republic of Korea.
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11
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Wang XH, Price SR. Organ Crosstalk Contributes to Muscle Wasting in Chronic Kidney Disease. Semin Nephrol 2023; 43:151409. [PMID: 37611335 DOI: 10.1016/j.semnephrol.2023.151409] [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] [Indexed: 08/25/2023]
Abstract
Muscle wasting (ie, atrophy) is a serious consequence of chronic kidney disease (CKD) that reduces muscle strength and function. It reduces the quality of life for CKD patients and increases the risks of comorbidities and mortality. Current treatment strategies to prevent or reverse skeletal muscle loss are limited owing to the broad and systemic nature of the initiating signals and the multifaceted catabolic mechanisms that accelerate muscle protein degradation and impair protein synthesis and repair pathways. Recent evidence has shown how organs such as muscle, adipose, and kidney communicate with each other through interorgan exchange of proteins and RNAs during CKD. This crosstalk changes cell functions in the recipient organs and represents an added dimension in the complex processes that are responsible for muscle atrophy in CKD. This complexity creates challenges for the development of effective therapies to ameliorate muscle wasting and weakness in patients with CKD.
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Affiliation(s)
- Xiaonan H Wang
- Renal Division, Department of Medicine, Emory University, Atlanta, GA
| | - S Russ Price
- Department of Biochemistry and Molecular Biology, Brody School of Medicine, East Carolina University, Greenville, NC; Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC.
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12
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Zang W, Fang M, He H, Mu L, Zheng X, Shu H, Ge N, Wang S. Comparative efficacy of exercise modalities for cardiopulmonary function in hemodialysis patients: A systematic review and network meta-analysis. Front Public Health 2022; 10:1040704. [PMID: 36530731 PMCID: PMC9751492 DOI: 10.3389/fpubh.2022.1040704] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Background To provide reliable evidence to exercise rehabilitation therapists and clinicians, we compared and analyzed the effects of different exercise modalities on cardiopulmonary function in hemodialysis patients using Bayesian network meta-analysis. Methods PubMed, OVID, Web of Science, Cochrane Library, Embase, Scopus, CINAHL, SPORT Discus, SinoMed, CNKI, Wanfang, and VIP were searched from inception to July 20, 2022. We included randomized controlled trials comparing 12 exercise modalities to improve cardiorespiratory fitness in hemodialysis patients. All statistical analysis was performed using STATA and R. Result A total of 82 randomized controlled trials involving 4146 maintenance hemodialysis patients were included in this study. The pair-wise meta-analysis showed that all exercise modalities had a positive effect on all indicators of cardiorespiratory capacity. The network meta-analysis demonstrated that Blood flow restriction training (BFRT), Cycle exercise (CE), Inspiratory muscle training (IMT), Combined aerobic and resistance training (CT), and Aerobic training (AT) were significantly better than usual care for 6-min walkability; Medium intensity continuous training (MICT), CT, CE, and AT were considerably better than usual care for VO2Peak; body and mind training (MBT) and CT significantly improved SBP compared to usual care; and only MBT was significantly better than usual care for DBP. Both the two-dimensional plot and the radar plot demonstrated that CT had the best combined-effect on each index of cardiorespiratory fitness. Subgroup and sensitivity analyses demonstrated the robustness of the results. The evidence was mainly "low" to "very low" for this network meta-analysis. Conclusion There is no one exercise that can achieve the best effect on all of the outcomes. The benefits of MBT in decreasing arterial blood pressure are unsurpassed by other exercise methods. The intervention effect of the CT is better and more stable. Electrical muscle stimulation training (MEST) can be employed in individuals who do not wish to exercise actively but may cause an increase in blood pressure. On the basis of the characteristics of different exercise types, guidelines developers, clinicians, and patients may employ them appropriately. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#recordDetails.
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Affiliation(s)
- Wanli Zang
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Mingqing Fang
- Xiangya Hospital, Central South University, Changsha, China
| | - He He
- Winter Olympic Academy, University of Harbin Sport, Harbin, China
| | - Liang Mu
- Winter Olympic Academy, University of Harbin Sport, Harbin, China,Postdoctoral Research Station, University of Harbin Sport, Harbin, China
| | - Xiaoqin Zheng
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Heng Shu
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Nan Ge
- School of Physical Education, South China Normal University, Guangzhou, China
| | - Su Wang
- Department of Sports Science, University of Harbin Sport, Harbin, China,*Correspondence: Su Wang
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13
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Riyono A, Tinduh D, Othman Z, Herawati L. Moderate intensity continuous and interval training affect visceral fat and insulin resistance model in female rat exposed high calorie diet. COMPARATIVE EXERCISE PHYSIOLOGY 2022. [DOI: 10.3920/cep220013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Chronic high-calorie diet (HCD) combined with physical inactivity promotes obesity and insulin resistance (IR). This study aimed to analyse the comparable effect of moderate-intensity continuous training (MICT) and moderate-intensity interval training (MIIT) on visceral fat weight and IR in subjects exposed to HCD. This randomised post-test research used only a control group design with female rats (Wistar norvegicus), 8 weeks old and 100-200 g of bodyweight. They were randomly divided into four groups: standard diet group (C), HCD group (C1), HCD combined with MICT group (C2) and HCD combined with MIIT group (C3). Each group consisted of six rats. HCD consisted of ad libitum standard diet plus dextrose solution by oral gavage for 4 weeks. The MICT was conducted by swimming plus 6% load of body weight for 10 min in the first week, for 20 min in the second week and 30 min in the third and fourth week. The MIIT was conducted by swimming in a ratio between swimming and rest time at 2:1 plus 6% load of BW, performed 5×/week for 4 weeks, and increased progressively. The mean body weight pre-intervention was 152.79±13.280 g and 150.12±9.195 g post-intervention (P=0.115). The mean fasting blood glucose pre-intervention was 79±8.668 mg/dl, and post-intervention 86.29±12.142 mg/dl (P=0.142). The mean visceral fat weight between C (1.94±0.66 g), C1 (1.45±0.47 g), C2 (1.41±0.44 g), and C3 (1.22±0.59 g) was not significant (P=0.179). The mean triglyceride level for C (173.33±30.30 mg/dl), C1 (157.16±47.32 mg/dl), C2 (112.83±25.49 mg/dl), and C3 (80.33±23.47 mg/dl) was significant (P=0.000). The mean IR model for C (4.796±0.070), C1 (4.728±0.125), C2 (4.620±0.123), C3 (4.360±0.143) was significant (P=0.000). In conclusion, both MICT and MIIT have an effect to improve IR and TG. The MIIT was more effective to improve IR compared to MICT in the female rats exposed to an HCD.
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Affiliation(s)
- A. Riyono
- Master Program of Basic Medicine Science, Faculty of Medicine, Universitas Airlangga, Jalan Mayjend Prof. Dr. Moestopo No. 4-8, Surabaya 60131, Indonesia
| | - D. Tinduh
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Airlangga, Jalan Mayjend Prof. Dr. Moestopo No. 4-8, Surabaya 60131, Indonesia
| | - Z. Othman
- Faculty of Health and Life Science, Management and Science University, Shah Alam, Selangor 40100, Malaysia
| | - L. Herawati
- Departement of Physiology, Faculty of Medicine, Universitas Airlangga, Jl Prof Dr Moestopo 47, Surabaya 60131, Indonesia
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14
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Exercise Training Ameliorates Renal Oxidative Stress in Rats with Chronic Renal Failure. Metabolites 2022; 12:metabo12090836. [PMID: 36144240 PMCID: PMC9504114 DOI: 10.3390/metabo12090836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 12/05/2022] Open
Abstract
In patients with chronic kidney disease, exercise training with moderate intensity protects renal function and improves mortality. However, the mechanisms of the renal protective effects of exercise training in chronic kidney disease have not been clarified. This study investigated the effects of exercise training on renal NADPH oxidative and xanthine oxidase, which are major sources of reactive oxygen species, in rats with chronic renal failure. Six-week-old, male Sprague–Dawley rats were divided into the sham operation, 5/6 nephrectomy (Nx)+ sedentary, and Nx+ exercise training groups. The Nx+ exercise training group underwent treadmill running. After 12 weeks, systolic blood pressure, renal function, malondialdehyde, renal NADPH oxidase, and xanthine oxidase were examined. Nx induced hypertension, proteinuria, and renal dysfunction, and exercise training attenuated these disorders. Although the plasma levels of malondialdehyde were not different among the group, urinary levels were increased by Nx and decreased by exercise training. Renal activity and expression of NADPH oxidase and xanthine oxidase were increased by Nx and decreased by exercise training. These results indicate that exercise training attenuates hypertension and renal dysfunction and ameliorates NADPH oxidase and xanthine oxidase in rats with chronic renal failure, suggesting that the reduction of reactive oxygen species generation may be involved in the renal protective effects of exercise training.
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15
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Armstrong A, Jungbluth Rodriguez K, Sabag A, Mavros Y, Parker HM, Keating SE, Johnson NA. Effect of aerobic exercise on waist circumference in adults with overweight or obesity: A systematic review and meta-analysis. Obes Rev 2022; 23:e13446. [PMID: 35383401 PMCID: PMC9540641 DOI: 10.1111/obr.13446] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/07/2022] [Accepted: 03/01/2022] [Indexed: 12/14/2022]
Abstract
Excess visceral adiposity contributes to elevated cardiometabolic risk, and waist circumference is commonly used as a surrogate measure of visceral adipose tissue. Although regular aerobic exercise is known to improve abdominal obesity, its effect on waist circumference is unclear. A systematic review and meta-analysis was performed to determine (1) the effect of aerobic exercise on waist circumference in adults with overweight or obesity; (2) the association between any change in waist circumference and change in visceral adipose tissue and/or bodyweight with aerobic exercise interventions; and (3) if reductions in waist circumference with exercise are moderated by clinical characteristics or components of aerobic exercise prescription. Twenty-five randomized controlled trials (1686 participants) were included. Regular aerobic exercise significantly reduced waist circumference by 3.2 cm (95% confidence interval [CI] -3.86, -2.51, p ≤ 0.001) versus control. Change in waist circumference was associated with change in visceral adipose tissue (β = 4.02; 95% CI 1.37, 6.66, p = 0.004), and vigorous intensity produced superior reduction (-4.2 cm, 95% CI -4.99, -3.42, p < 0.0001) in waist circumference compared with moderate intensity (-2.50 cm, 95% CI -3.22, -1.79, p = 0.058). These findings suggest regular aerobic exercise results in modest reductions in waist circumference and associated visceral adipose tissue and that higher intensity exercise may offer superior benefit to moderate intensity.
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Affiliation(s)
- Alex Armstrong
- Faculty of Medicine and Health, Discipline of Exercise and Sport Science, University of Sydney, Sydney, New South Wales.,Charles Perkins Centre, University of Sydney, Camperdown, New South Wales
| | - Klaus Jungbluth Rodriguez
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - Angelo Sabag
- NICM Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Yorgi Mavros
- Faculty of Medicine and Health, Discipline of Exercise and Sport Science, University of Sydney, Sydney, New South Wales.,Charles Perkins Centre, University of Sydney, Camperdown, New South Wales
| | - Helen M Parker
- Faculty of Medicine and Health, Discipline of Exercise and Sport Science, University of Sydney, Sydney, New South Wales
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - Nathan A Johnson
- Faculty of Medicine and Health, Discipline of Exercise and Sport Science, University of Sydney, Sydney, New South Wales.,Charles Perkins Centre, University of Sydney, Camperdown, New South Wales
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16
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Moecke DMP, Martins GHC, Garlet TC, Bonorino KC, Luciani MG, Bion M, Dos Santos B, da Silva Gevaerd M, Filho JA, Dos Santos ARS, Vieira DSC, Dafre AL, de Camargo Hizume Kunzler D. Aerobic Exercise Attenuates Kidney Injury, Improves Physical Performance, and Increases Antioxidant Defenses in Lungs of Adenine-Induced Chronic Kidney Disease Mice. Inflammation 2022; 45:1895-1910. [PMID: 35727396 DOI: 10.1007/s10753-022-01643-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 12/30/2021] [Accepted: 01/28/2022] [Indexed: 11/05/2022]
Abstract
The association between chronic kidney disease (CKD) and pulmonary pathophysiological changes is well stablished. Nevertheless, the effects of aerobic exercise (AE) on lungs of CKD need further clarification. Thus, Swiss mice were divided in control, AE, CKD, and CKD + AE groups. CKD was induced by 0.2% adenine intake during 8 weeks (4 weeks of CKD induction and 4 weeks of AE). AE consisted in running on treadmill, at moderate intensity, 30 min/day, 5 days/week, during 4 weeks. Twenty-four hours after the last training day, functional capacity test was performed, and 48 h after the test, mice were euthanized. CKD mice showed a significant increase in urine output, serum urea, and creatinine concentrations, and decreased body weight and urine density, besides oxidative damage (p = 0.044), edema area (p < 0.001), leukocyte infiltration (p = 0.040), and collagen area in lung tissue (p = 0.004). AE resulted in an increase of distance traveled (p = 0.049) and maximum speed (p = 0.046), increased activity of catalase (p = 0.031) and glutathione peroxidase (p = 0.048) in lungs, increased levels of nitric oxide (NOx) in serum (p = 0.001) and bronchoalveolar lavage fluid (p = 0.047), and decreased kidney histological injury (p = 0.018) of CKD mice. However, AE also increased oxidative damage (p = 0.003) and did not change collagen content or perivascular edema in lungs (p > 0.05) of CKD mice. Therefore, AE attenuated kidney injury and improved antioxidants defenses in lungs. Despite no significant changes in pulmonary damage, AE significantly improved physical performance in CKD mice.
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Affiliation(s)
- Débora Melissa Petry Moecke
- Universidade Estadual de Santa Catarina (UDESC), Physical Therapy Graduate Program (PPG-Ft), Health and Sport Sciences Center (CEFID), Experimental Research Laboratory (LaPEx), R. Pascoal Simone, 358, Coqueiros, Florianópolis, ZIP Code: 88080-350, Santa Catarina, Brazil
| | - Gisele Henrique Cardoso Martins
- Laboratory of Cellular Defense (LABDEF), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Thaine Cristina Garlet
- Universidade Estadual de Santa Catarina (UDESC), Physical Therapy Graduate Program (PPG-Ft), Health and Sport Sciences Center (CEFID), Experimental Research Laboratory (LaPEx), R. Pascoal Simone, 358, Coqueiros, Florianópolis, ZIP Code: 88080-350, Santa Catarina, Brazil
| | - Kelly Cattelan Bonorino
- Laboratory of Neurobiology of Pain and Inflammation (LANDI), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Marilia Gabriela Luciani
- Center for Agricultural Sciences (CAV), Universidade Estadual de Santa Catarina (UDESC), Lages, Santa Catarina, Brazil
| | - Monique Bion
- Laboratory of Cellular Defense (LABDEF), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Barbara Dos Santos
- Laboratory of Cellular Defense (LABDEF), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Monique da Silva Gevaerd
- Universidade Estadual de Santa Catarina (UDESC), Physical Therapy Graduate Program (PPG-Ft), Health and Sport Sciences Center (CEFID), Experimental Research Laboratory (LaPEx), R. Pascoal Simone, 358, Coqueiros, Florianópolis, ZIP Code: 88080-350, Santa Catarina, Brazil
| | - Jamil Assreuy Filho
- Nitric Oxide Pharmacology Laboratory, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Adair Roberto Soares Dos Santos
- Laboratory of Neurobiology of Pain and Inflammation (LANDI), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Daniella Serafin Couto Vieira
- Polydoro Ernani de São Thiago University Hospital, Universidade Federal de Santa Catarina (HU/UFSC), Pathological Anatomy Service, Florianópolis, Santa Catarina, Brazil
| | - Alcir Luiz Dafre
- Laboratory of Cellular Defense (LABDEF), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Deborah de Camargo Hizume Kunzler
- Universidade Estadual de Santa Catarina (UDESC), Physical Therapy Graduate Program (PPG-Ft), Health and Sport Sciences Center (CEFID), Experimental Research Laboratory (LaPEx), R. Pascoal Simone, 358, Coqueiros, Florianópolis, ZIP Code: 88080-350, Santa Catarina, Brazil.
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17
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Baker LA, March DS, Wilkinson TJ, Billany RE, Bishop NC, Castle EM, Chilcot J, Davies MD, Graham-Brown MPM, Greenwood SA, Junglee NA, Kanavaki AM, Lightfoot CJ, Macdonald JH, Rossetti GMK, Smith AC, Burton JO. Clinical practice guideline exercise and lifestyle in chronic kidney disease. BMC Nephrol 2022; 23:75. [PMID: 35193515 PMCID: PMC8862368 DOI: 10.1186/s12882-021-02618-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Mark D. Davies
- Betsi Cadwaladr University Health Board and Bangor University, Bangor, UK
| | | | | | | | | | | | - Jamie H. Macdonald
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | | | | | - James O. Burton
- University of Leicester and Leicester Hospitals NHS Trust, Leicester, UK
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18
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Chatzipetrou V, Bégin MJ, Hars M, Trombetti A. Sarcopenia in Chronic Kidney Disease: A Scoping Review of Prevalence, Risk Factors, Association with Outcomes, and Treatment. Calcif Tissue Int 2022; 110:1-31. [PMID: 34383112 PMCID: PMC8732833 DOI: 10.1007/s00223-021-00898-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/29/2021] [Indexed: 12/14/2022]
Abstract
Sarcopenia, a condition characterized by loss of skeletal muscle mass and function, has important clinical ramifications. We aimed to map the existing literature about prevalence, risk factors, associated adverse outcomes, and treatment of sarcopenia in individuals with chronic kidney disease (CKD). A scoping review of the literature was conducted to identify relevant articles published from databases' inception to September 2019. Individuals with CKD, regardless of their disease stage and their comorbidities, were included. Only studies with sarcopenia diagnosed using both muscle mass and function, based on published consensus definitions, were included. For studies on treatment, only randomized controlled trials with at least one sarcopenia parameter as an outcome were included. Our search yielded 1318 articles, of which 60 from were eligible for this review. The prevalence of sarcopenia ranged from 4 to 42% according to the definition used, population studied, and the disease stage. Several risk factors for sarcopenia were identified including age, male gender, low BMI, malnutrition, and high inflammatory status. Sarcopenia was found to be associated with several adverse outcomes, including disabilities, hospitalizations, and mortality. In CKD subjects, several therapeutic interventions have been assessed in randomized controlled trial with a muscle mass, strength, or function endpoint, however, studies focusing on sarcopenic CKD individuals are lacking. The key interventions in the prevention and treatment of sarcopenia in CKD seem to be aerobic and resistance exercises along with nutritional interventions. Whether these interventions are effective to treat sarcopenia and prevent clinical consequences in this population remains to be fully determined.
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Affiliation(s)
- Varvara Chatzipetrou
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Marie-Josée Bégin
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Mélany Hars
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
- Division of Geriatrics, Department of Readaptation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland
| | - Andrea Trombetti
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
- Division of Geriatrics, Department of Readaptation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland.
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19
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Kotake H, Yamada S, Ogura Y, Watanabe S, Inoue K, Ichikawa D, Sugaya T, Ohata K, Natsuki Y, Hoshino S, Watanabe M, Kimura K, Shibagaki Y, Kamijo-Ikemori A. Endurance exercise training-attenuated diabetic kidney disease with muscle weakness in spontaneously diabetic Torii fatty rats. Kidney Blood Press Res 2021; 47:203-218. [PMID: 34923497 DOI: 10.1159/000521464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/11/2021] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this study was to evaluate protective effects of endurance exercise training against diabetic kidney disease (DKD) with muscle weakness by using male spontaneously diabetic Torii (SDT) fatty rats as type 2 diabetic animal models with obesity, hypertension, and hyperlipidemia. Methods Eight-week-old SDT fatty rats (n = 12) and Sprague-Dawley (SD) rats (n = 10) were randomly divided into exercise (Ex; SDT-Ex: n = 6, SD-Ex: n = 5) and sedentary groups (SDT-Cont: n = 6, SD-Cont: n = 5), respectively. Each group underwent regular treadmill exercise four times a week from ages 8 to 16 weeks. Results The exercise attenuated hypertension and hyperlipidemia and prevented increases in renal parameter levels without affecting blood glucose levels. In the SDT fatty rats, it prevented induction of renal morphological abnormalities in the interstitium of the superficial and intermediate layers of the cortex. Downregulated expression of endothelial nitric oxide synthase in the glomerulus of the SDT fatty rats was significantly upregulated by the exercise. The exercise upregulated the renal expressions of both medium-chain acyl-CoA dehydrogenase and peroxisome proliferator-activated receptor γ coactivator-1α related to fatty acid metabolism. It increased muscle strength and both muscle weight and cross-sectional area of type IIb muscle fibers in the extensor digitorum longus muscle in the SDT fatty rats. Conclusion Endurance exercise training in type 2 diabetes ameliorates DKD by improving endothelial abnormality and enhancing fatty acid metabolism in addition to attenuated hypertension, hyperlipidemia, and muscle weakness independently of blood glucose levels.
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Affiliation(s)
- Hitoshi Kotake
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shohei Yamada
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yuji Ogura
- Department of Physiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shiika Watanabe
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kazuho Inoue
- Department of Anatomy, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Daisuke Ichikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeshi Sugaya
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Keiichi Ohata
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yasunori Natsuki
- Institute for Ultrastructural Morphology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Seiko Hoshino
- Department of Anatomy, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Minoru Watanabe
- Institute for Animal Experimentation, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| | | | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Atsuko Kamijo-Ikemori
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Anatomy, St. Marianna University School of Medicine, Kawasaki, Japan
- Institute for Animal Experimentation, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
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20
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Nishiguchi Y, Hata Y, Date R, Fujimoto D, Umemoto S, Kanki T, Yokoi H, Mori KP, Handa T, Watanabe-Takano H, Kanai Y, Yasoda A, Izumi Y, Kakizoe Y, Mochizuki N, Mukoyama M, Kuwabara T. Osteocrin, a bone-derived humoral factor, exerts a renoprotective role in ischemia-reperfusion injury in mice. Nephrol Dial Transplant 2021; 37:444-453. [PMID: 34610136 PMCID: PMC8875462 DOI: 10.1093/ndt/gfab286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Indexed: 12/11/2022] Open
Abstract
Background Osteocrin (OSTN), a bone-derived humoral factor, was reported to act on heart and bone by potentiating the natriuretic peptide (NP) system. Ostn gene polymorphisms have been associated with renal function decline, but its pathophysiological role in the kidney remains unclear. Methods The role of endogenous OSTN was investigated using systemic Ostn-knockout (KO) mice. As a model for OSTN administration, liver-specific Ostn-overexpressing mice crossed with KO (KO-Tg) were generated. These mice were subjected to unilateral ischemia–reperfusion injury (IRI) and renal lesions after 21 days of insult were evaluated. A comprehensive analysis of the Wnt/β-catenin pathway was performed using a polymerase chain reaction (PCR) array. Reporter plasmid-transfected proximal tubular cells (NRK52E) were used to investigate the mechanism by which OSTN affects the pathway. Results After injury, KO mice showed marginal worsening of renal fibrosis compared with wild-type mice, with comparable renal atrophy. KO-Tg mice showed significantly ameliorated renal atrophy, fibrosis and tubular injury, together with reduced expressions of fibrosis- and inflammation-related genes. The PCR array showed that the activation of the Wnt/β-catenin pathway was attenuated in KO-Tg mice. The downstream targets Mmp7, Myc and Axin2 showed similar results. MMP7 and Wnt2 were induced in corticomedullary proximal tubules after injury, but not in KO-Tg. In NRK52E, OSTN significantly potentiated the inhibitory effects of NP on transforming growth factor β1–induced activation of the Wnt/β-catenin pathway, which was reproduced by a cyclic guanosine monophosphate analog. Conclusions Ectopic Ostn overexpression ameliorated subsequent renal injury following ischemia–reperfusion. OSTN could represent possible renoprotection in acute to chronic kidney disease transition, thus serving as a potential therapeutic strategy.
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Affiliation(s)
- Yoshihiko Nishiguchi
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Yusuke Hata
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Ryosuke Date
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Daisuke Fujimoto
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Shuro Umemoto
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Tomoko Kanki
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Hideki Yokoi
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Keita P Mori
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takaya Handa
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Haruko Watanabe-Takano
- Department of Cell Biology, National Cerebral and Cardiovascular Center, Research Institute, Osaka, Japan
| | - Yugo Kanai
- Department of Diabetes Mellitus and Endocrinology, Osaka Red Cross Hospital, Osaka, Japan
| | - Akihiro Yasoda
- Clinical Research Center, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yuichiro Izumi
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Yutaka Kakizoe
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Naoki Mochizuki
- Department of Cell Biology, National Cerebral and Cardiovascular Center, Research Institute, Osaka, Japan
| | - Masashi Mukoyama
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Takashige Kuwabara
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
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21
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Home-Based Exercise for People With Chronic Kidney Disease: A Systematic Review and Meta-Analysis. J Phys Act Health 2021; 18:1143-1154. [PMID: 34407509 DOI: 10.1123/jpah.2020-0652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Exercise performed at home could be a useful therapy for people with chronic kidney disease. This systematic review and meta-analysis aimed at describing the characteristics, main findings, methodological quality, and adherence rate reported in the existent randomized controlled trials that have provided information regarding the impact of home-based exercise programs on people with chronic kidney disease. METHODS Electronic databases (MEDLINE/PubMed, SPORTDiscus, Scopus, and CENTRAL) were searched up to April 2021, using the keywords: "Exercise"; "Home"; "Kidney Disease." Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was adopted. Jadad scale and Cochrane's tool were used to assess the methodological quality and risk of bias. RESULTS Out of the 14 studies finally selected, 11 were included in the meta-analysis and most presented high methodological quality. The meta-analysis showed significant effects of home-based exercise on fitness and quality of life, but a little impact on renal function. Although exercise performed at home was mostly feasible and safe, adherence was not high and a considerable number of dropouts were observed. CONCLUSION Home-based exercise has positive effects on the fitness' level and on the quality of life on people with chronic kidney disease. Future studies are needed to identify whether exercise performed at home is a better physical therapy option than center-based exercise.
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22
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Grazioli E, Romani A, Marrone G, Di Lauro M, Cerulli C, Urciuoli S, Murri A, Guerriero C, Tranchita E, Tesauro M, Parisi A, Di Daniele N, Noce A. Impact of Physical Activity and Natural Bioactive Compounds on Endothelial Dysfunction in Chronic Kidney Disease. Life (Basel) 2021; 11:life11080841. [PMID: 34440585 PMCID: PMC8402113 DOI: 10.3390/life11080841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/21/2021] [Accepted: 08/11/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic kidney disease (CKD) represents a world-wide public health problem. Inflammation, endothelial dysfunction (ED) and vascular calcifications are clinical features of CKD patients that increase cardiovascular (CV) mortality. CKD-related CV disease pathogenic mechanisms are not only associated with traditional factors such as arterial hypertension and dyslipidemia, but also with ED, oxidative stress and low-grade inflammation. The typical comorbidities of CKD contribute to reduce the performance and the levels of the physical activity in nephropathic patients compared to healthy subjects. Currently, the effective role of physical activity on ED is still debated, but the available few literature data suggest its positive contribution. Another possible adjuvant treatment of ED in CKD patients is represented by natural bioactive compounds (NBCs). Among these, minor polar compounds of extra virgin olive oil (hydroxytyrosol, tyrosol and oleocanthal), polyphenols, and vitamin D seem to exert a beneficial role on ED in CKD patients. The objective of the review is to evaluate the effectiveness of physical exercise protocols and/or NBCs on ED in CKD patients.
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Affiliation(s)
- Elisa Grazioli
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy; (E.G.); (C.C.); (A.M.); (E.T.); (A.P.)
| | - Annalisa Romani
- PHYTOLAB (Pharmaceutical, Cosmetic, Food Supplement, Technology and Analysis), DiSIA, University of Florence, Via Ugo Schiff 6, 50019 Sesto Fiorentino, Florence, Italy; (A.R.); (S.U.)
| | - Giulia Marrone
- UOC of Internal Medicine—Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (C.G.); (N.D.D.)
| | - Manuela Di Lauro
- UOC of Internal Medicine—Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (C.G.); (N.D.D.)
| | - Claudia Cerulli
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy; (E.G.); (C.C.); (A.M.); (E.T.); (A.P.)
| | - Silvia Urciuoli
- PHYTOLAB (Pharmaceutical, Cosmetic, Food Supplement, Technology and Analysis), DiSIA, University of Florence, Via Ugo Schiff 6, 50019 Sesto Fiorentino, Florence, Italy; (A.R.); (S.U.)
| | - Arianna Murri
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy; (E.G.); (C.C.); (A.M.); (E.T.); (A.P.)
| | - Cristina Guerriero
- UOC of Internal Medicine—Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (C.G.); (N.D.D.)
| | - Eliana Tranchita
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy; (E.G.); (C.C.); (A.M.); (E.T.); (A.P.)
| | - Manfredi Tesauro
- UOC of Internal Medicine—Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (C.G.); (N.D.D.)
- Correspondence: (M.T.); (A.N.); Tel.: +39-06-2090-2982 (M.T.); +39-06-2090-2194 (A.N.)
| | - Attilio Parisi
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy; (E.G.); (C.C.); (A.M.); (E.T.); (A.P.)
| | - Nicola Di Daniele
- UOC of Internal Medicine—Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (C.G.); (N.D.D.)
| | - Annalisa Noce
- UOC of Internal Medicine—Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (C.G.); (N.D.D.)
- Correspondence: (M.T.); (A.N.); Tel.: +39-06-2090-2982 (M.T.); +39-06-2090-2194 (A.N.)
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23
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Wu L, Liu Y, Wu L, Yang J, Jiang T, Li M. Effects of exercise on markers of inflammation and indicators of nutrition in patients with chronic kidney disease: a systematic review and meta-analysis. Int Urol Nephrol 2021; 54:815-826. [PMID: 34255271 DOI: 10.1007/s11255-021-02949-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE This meta-analysis aimed to reveal the effects of exercise training on markers of inflammation and indicators of nutrition in non-dialysis-dependent patients with chronic kidney disease (NDD-CKD). METHODS We searched the MEDLINE, EMBASE, CENTRAL, Web of Science, CINAHL, CNKI, WANFANE, VIP, and CBM databases, from their inception up to October 2020 to identify randomized controlled trials that examined the effects of exercise training on inflammation and nutrition in NDD-CKD patients. A total of 16 trials, comprising 724 patients, were included in the analysis. RESULTS The BMI (P = 0.005) and waist circumference (P = 0.004) decreased significantly after exercise training in NDD-CKD patients. Similarly, IL-6 (P = 0.03) decreased after exercise training in NDD-CKD patients. However, serum albumin level, body fat, CRP and hs-CRP were not different between patients who received exercise training and those who received usual care. Furthermore, BMI (P = 0.009), body weight (P = 0.009), and waist circumference (P = 0.010) were decreased in overweight patients (BMI ≧ 25 kg/m2). Moreover, BMI (P = 0.003), body weight (P = 0.005), and waist circumference (P = 0.007) reduced when the length of intervention exceeded 48 weeks. Subgroup analyses revealed no significant alteration of serum albumin, body fat, CRP, or hs-CRP, when studies were divided based on BMI or intervention duration. CONCLUSION Overall, these findings suggest that exercise training may improve inflammation status in NDD-CKD patients, and enhance weight loss in obese adult CKD patients. Registration number: INPLASY2020100025.
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Affiliation(s)
- Lihua Wu
- Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Yu Liu
- Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Ling Wu
- Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Ju Yang
- Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Ting Jiang
- Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Mingquan Li
- Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China.
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24
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Koito Y, Yanishi M, Kimura Y, Tsukaguchi H, Kinoshita H, Matsuda T. Serum Brain-Derived Neurotrophic Factor and Myostatin Levels Are Associated With Skeletal Muscle Mass in Kidney Transplant Recipients. Transplant Proc 2021; 53:1939-1944. [PMID: 34253381 DOI: 10.1016/j.transproceed.2021.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/01/2021] [Accepted: 04/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sarcopenia, or reduced muscle mass, can be an important complication in kidney transplant recipients. The skeletal muscles were recently reported to secrete various myokines, such as brain-derived neurotrophic factor (BDNF) and myostatin, to regulate their mass, function, or both. The aim of the present study was to analyze the interrelationship between myokines (BDNF and myostatin) and skeletal muscle mass in kidney transplant recipients. METHODS The study population comprised 40 patients who underwent kidney transplantation at Kansai Medical University Hospital. Twenty patients had low skeletal muscle mass index (SMI) values, as measured on dual-energy x-ray absorptiometry, and were categorized into 2 groups (low SMI and normal). RESULTS Mean serum BDNF levels were 15.7 ng/mL in the low SMI group and 17.8 ng/mL in the normal group (P = .013). Mean serum myostatin levels were 362 pg/mL in the low SMI and 267 pg/mL in the normal group (P = .024). There was a significant positive correlation among metabolic equivalents and serum BDNF levels (r = 0.817; P < .001) and a significant negative correlation among metabolic equivalents and serum myostatin levels (r = -0.541; P < .001). Receiver operating characteristic analysis showed that serum BDNF and level of area under curve was 0.712, and serum myostatin level of area under the curve was 0.690. Serum BDNF and myostatin levels showed no significant difference. CONCLUSION These results suggest that BDNF and myostatin are potential biomarkers of reduced muscle mass in kidney transplant recipients.
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Affiliation(s)
- Yuya Koito
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Masaaki Yanishi
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
| | - Yutaka Kimura
- Health Science Center, Kansai Medical University, Osaka, Japan
| | - Hiroyasu Tsukaguchi
- Second Department of Internal Medicine, Division of Nephrology, Kansai Medical University, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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25
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Sex Difference in the Association between Physical Activity and All-Cause Mortality in Ambulatory Patients with Chronic Kidney Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073698. [PMID: 33916240 PMCID: PMC8036673 DOI: 10.3390/ijerph18073698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 02/06/2023]
Abstract
(1) Background: The purpose of this article was to investigate the association between self-reported physical activity (PA) and all-cause mortality in ambulatory patients with chronic kidney disease (CKD), stage 4–5 including maintenance dialysis. (2) Methods: Ambulatory patients with CKD (eGFR < 30 mL/min/1.73 m2) with conservative treatment or chronic dialysis were included. PA was assessed using the Saltin–Grimby Physical Activity Level Scale. A Cox proportional hazards regression model––adjusted for age, sex, plasma–albumin, body mass index, socioeconomic status, and treatment––was applied. (3) Results: Participants (n = 374) were followed 39 ± 15 months from entry to death or censoring. Throughout the study period of 39 months, 156 deaths (42%) were registered. Regarding physical activity, 128 (34%) of the participants were inactive, 212 (57%) were moderately active, and 34 (9%) were highly or vigorously active. Moderate PA was associated with a decreased mortality risk in women (n = 150) compared to inactivity (HR 0.27 (0.15; 0.51), p < 0.001), whereas a high/vigorous level of PA was not significantly associated with mortality risk compared to inactivity. In men (n = 224), the associations between PA levels and mortality risk were not significant. (4) Conclusions: Moderate PA was associated with reduced all-cause mortality in ambulatory women with stage 4–5 CKD with or without maintenance dialysis treatment. Physical activity was not significantly associated with mortality in men.
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26
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Conley MM, McFarlane CM, Johnson DW, Kelly JT, Campbell KL, MacLaughlin HL. Interventions for weight loss in people with chronic kidney disease who are overweight or obese. Cochrane Database Syst Rev 2021; 3:CD013119. [PMID: 33782940 PMCID: PMC8094234 DOI: 10.1002/14651858.cd013119.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Obesity and chronic kidney disease (CKD) are highly prevalent worldwide and result in substantial health care costs. Obesity is a predictor of incident CKD and progression to kidney failure. Whether weight loss interventions are safe and effective to impact on disease progression and clinical outcomes, such as death remains unclear. OBJECTIVES This review aimed to evaluate the safety and efficacy of intentional weight loss interventions in overweight and obese adults with CKD; including those with end-stage kidney disease (ESKD) being treated with dialysis, kidney transplantation, or supportive care. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 14 December 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs of more than four weeks duration, reporting on intentional weight loss interventions, in individuals with any stage of CKD, designed to promote weight loss as one of their primary stated goals, in any health care setting. DATA COLLECTION AND ANALYSIS Two authors independently assessed study eligibility and extracted data. We applied the Cochrane 'Risk of Bias' tool and used the GRADE process to assess the certainty of evidence. We estimated treatment effects using random-effects meta-analysis. Results were expressed as risk ratios (RR) for dichotomous outcomes together with 95% confidence intervals (CI) or mean differences (MD) or standardised mean difference (SMD) for continuous outcomes or in descriptive format when meta-analysis was not possible. MAIN RESULTS We included 17 RCTs enrolling 988 overweight or obese adults with CKD. The weight loss interventions and comparators across studies varied. We categorised comparisons into three groups: any weight loss intervention versus usual care or control; any weight loss intervention versus dietary intervention; and surgical intervention versus non-surgical intervention. Methodological quality was varied, with many studies providing insufficient information to accurately judge the risk of bias. Death (any cause), cardiovascular events, successful kidney transplantation, nutritional status, cost effectiveness and economic analysis were not measured in any of the included studies. Across all 17 studies many clinical parameters, patient-centred outcomes, and adverse events were not measured limiting comparisons for these outcomes. In studies comparing any weight loss intervention to usual care or control, weight loss interventions may lead to weight loss or reduction in body weight post intervention (6 studies, 180 participants: MD -3.69 kg, 95% CI -5.82 to -1.57; follow-up: 5 weeks to 12 months, very low-certainty evidence). In very low certainty evidence any weight loss intervention had uncertain effects on body mass index (BMI) (4 studies, 100 participants: MD -2.18 kg/m², 95% CI -4.90 to 0.54), waist circumference (2 studies, 53 participants: MD 0.68 cm, 95% CI -7.6 to 6.24), proteinuria (4 studies, 84 participants: 0.29 g/day, 95% CI -0.76 to 0.18), systolic (4 studies, 139 participants: -3.45 mmHg, 95% CI -9.99 to 3.09) and diastolic blood pressure (4 studies, 139 participants: -2.02 mmHg, 95% CI -3.79 to 0.24). Any weight loss intervention made little or no difference to total cholesterol, high density lipoprotein cholesterol, and inflammation, but may lower low density lipoprotein cholesterol. There was little or no difference between any weight loss interventions (lifestyle or pharmacological) compared to dietary-only weight loss interventions for weight loss, BMI, waist circumference, proteinuria, and systolic blood pressure, however diastolic blood pressure was probably reduced. Furthermore, studies comparing the efficacy of different types of dietary interventions failed to find a specific dietary intervention to be superior for weight loss or a reduction in BMI. Surgical interventions probably reduced body weight (1 study, 11 participants: MD -29.50 kg, 95% CI -36.4 to -23.35), BMI (2 studies, 17 participants: MD -10.43 kg/m², 95% CI -13.58 to -7.29), and waist circumference (MD -30.00 cm, 95% CI -39.93 to -20.07) when compared to non-surgical weight loss interventions after 12 months of follow-up. Proteinuria and blood pressure were not reported. All results across all comparators should be interpreted with caution due to the small number of studies, very low quality of evidence and heterogeneity across interventions and comparators. AUTHORS' CONCLUSIONS All types of weight loss interventions had uncertain effects on death and cardiovascular events among overweight and obese adults with CKD as no studies reported these outcome measures. Non-surgical weight loss interventions (predominately lifestyle) appear to be an effective treatment to reduce body weight, and LDL cholesterol. Surgical interventions probably reduce body weight, waist circumference, and fat mass. The current evidence is limited by the small number of included studies, as well as the significant heterogeneity and a high risk of bias in most studies.
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Affiliation(s)
- Marguerite M Conley
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Australia
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
| | | | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Jaimon T Kelly
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
| | - Katrina L Campbell
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
| | - Helen L MacLaughlin
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
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27
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Kuo CP, Tsai MT, Lee KH, Lin YP, Huang SS, Huang CC, Tseng WC, Tarng DC. Dose-response effects of physical activity on all-cause mortality and major cardiorenal outcomes in chronic kidney disease. Eur J Prev Cardiol 2021; 29:452-461. [PMID: 33704426 DOI: 10.1093/eurjpc/zwaa162] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 12/18/2022]
Abstract
AIMS Physical activity has a protective effect against mortality and cardiovascular events in chronic kidney disease (CKD) patients. Nonetheless, how different levels of physical activity affect the health benefits in CKD remains unclear. This study aimed to investigate the dose-response effects of physical activity on mortality and major cardiorenal events in CKD. METHODS AND RESULTS We evaluated a longitudinal cohort of 4508 Taiwanese CKD patients between 2004 and 2017. Physical activity was assessed by the NHANES questionnaire and quantified in metabolic equivalent-hours per week (MET-hour/week). Patients were categorized into highly active (≥7.5 MET-h/week), low-active (0.1 to <7.5 MET-h/week), or inactive (0 MET-h/week) groups. Cox regression and restricted cubic spline models were utilized to explore the association between physical activity and the risks of study outcomes, including all-cause mortality, end-stage renal disease (ESRD), and major adverse cardiovascular events (MACE, a composite of cardiovascular death, myocardial infarction, ischaemic stroke, and hospitalized heart failure). During a median follow-up of 686 days, 739 death, 1059 ESRD, and 521 MACE events occurred. Highly active group had the lowest chance of all study outcomes, followed by low-active and inactive groups (P < 0.001). Multivariable Cox regression showed that only highly active group was independently associated with lower risks for all-cause mortality [hazard ratio (HR) 0.62; 95% confidence interval (CI) 0.53-0.74], ESRD (HR 0.83, 95% CI 0.72-0.96), and MACE (HR 0.63, 95% CI 0.51-0.76) compared to the inactive group. The risks of MACE did not further decrease once physical activity surpassed 15 MET-h/week, indicating a U-shaped association. The results were consistent in the subgroup and sensitivity analyses. CONCLUSION Physical activity of 7.5 to <15 MET-h/week is associated with lower risks of adverse cardiorenal outcomes and should be integrated into the care of CKD.
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Affiliation(s)
- Chou-Pin Kuo
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan
| | - Ming-Tsun Tsai
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan.,Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan
| | - Kuo-Hua Lee
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan.,Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan
| | - Yao-Ping Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan
| | - Shao-Sung Huang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.,Healthcare and Services Center, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Chin-Chou Huang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Wei-Cheng Tseng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan.,Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan.,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Chiao-Tung University, Hsinchu 30010, Taiwan.,Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao-Tung University, Hsinchu 30010, Taiwan
| | - Der-Cherng Tarng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan.,Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan.,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Chiao-Tung University, Hsinchu 30010, Taiwan.,Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao-Tung University, Hsinchu 30010, Taiwan.,Department and Institute of Physiology, National Yang-Ming University, Taipei 11221, Taiwan
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28
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Yamamoto R, Ito T, Nagasawa Y, Matsui K, Egawa M, Nanami M, Isaka Y, Okada H. Efficacy of aerobic exercise on the cardiometabolic and renal outcomes in patients with chronic kidney disease: a systematic review of randomized controlled trials. J Nephrol 2021; 34:155-164. [PMID: 33387341 DOI: 10.1007/s40620-020-00865-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/14/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Several randomized controlled trials (RCTs) have demonstrated the cardiometabolic effects of aerobic exercise in the general population and in patients with cardiovascular diseases. However, the efficacy of aerobic exercise in patients with chronic kidney disease (CKD) remains to be elucidated. METHODS RCTs comparing aerobic exercise with no aerobic exercise in patients with CKD not requiring kidney replacement therapy were identified through PubMed using RobotAnalyst, a web-based software system that combines text-mining and machine learning algorithms for organizing references. Cardiometabolic and renal outcomes of interest included body mass index (BMI); systolic blood pressure (SBP); hemoglobin A1c (HbA1c), total cholesterol (TCHO), low- and high- density lipoprotein cholesterol (LDLC and HDLC, respectively), and urinary protein (UP) levels/concentration; peak oxygen uptake (Vo2peak); and glomerular filtration rate (GFR) at the end of the follow-up period. The standardized mean difference (SMD) of each outcome was estimated using the DerSimonian-Laird random-effect model with inverse-variance weighting. RESULTS A total of 15 trials, including 622 patients, were included. Their follow-up periods were 3-4, 6-12, and > 12-months in 7 (46.7%), 7 (46.7%), and 1 (6.7%) trial(s), respectively. Meta-analyses showed that aerobic exercise significantly decreased BMI (SMD, -0.19 [95% confidence interval, -0.38, -0.00]) and SBP (-0.75 [-1.24, -0.26]) and increased Vo2peak (0.54 [0.29, 0.78]); however, no significant association was observed in HbA1c, TCHO, HDLC, LDLC, GFR, and UP. Meta-regression models suggested that aerobic exercise was more likely to improve Vo2peak in patients with younger age, no diabetes, and lower BMI. CONCLUSION Aerobic exercise of 3-12 months' duration improved obesity, high blood pressure, and low exercise capacity in overweight/obese patients with CKD, but it had no significant effect on GFR and proteinuria. Well-designed large RCTs with a longer follow-up period are needed to evaluate the efficacy of aerobic exercise in patients with CKD.
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Affiliation(s)
- Ryohei Yamamoto
- Health and Counseling Center, Osaka University, 1-17 Machikaneyama-cho, Toyonaka, Osaka, 560-0043, Japan. .,Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan. .,Health Promotion and Regulation, Department of Health Promotion Medicine, Osaka University Graduate School of Medicine, Toyonaka, Japan.
| | - Takafumi Ito
- Division of Nephrology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yasuyuki Nagasawa
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kosuke Matsui
- Department of Nephrology, Izumo Citizens Hospital, Izumo, Japan
| | - Masahiro Egawa
- Division of Nephrology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Masayoshi Nanami
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hirokazu Okada
- Department of Nephrology, Saitama Medical University, Iruma-gun, Saitama, Japan
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Zhou Y, Hellberg M, Hellmark T, Höglund P, Clyne N. Muscle mass and plasma myostatin after exercise training: a substudy of Renal Exercise (RENEXC)-a randomized controlled trial. Nephrol Dial Transplant 2021; 36:95-103. [PMID: 31848626 PMCID: PMC7771980 DOI: 10.1093/ndt/gfz210] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sarcopenia increases as renal function declines and is associated with higher morbidity and mortality. Myostatin is a negative regulator of muscle growth. Its expression in response to exercise is unclear. In this prespecified substudy of the Renal Exercise (RENEXC) trial, we investigated the effects of 12 months of exercise training on sarcopenia, muscle mass and plasma myostatin and the relationships between physical performance, muscle mass and plasma myostatin. METHODS A total of 151 non-dialysis-dependent patients (average measured glomerular filtration rate 23 ± 8 mL/min/1.73 m2), irrespective of age or comorbidity, were randomly assigned to either strength or balance in combination with endurance training. Body composition was measured with dual-energy X-ray absorptiometry. Plasma myostatin was analysed using enzyme-linked immunosorbent assay kits. RESULTS After 12 months, the prevalence of sarcopenia was unchanged, leg and whole-body lean mass increased significantly in the balance group and was unchanged in the strength group. Whole fat mass decreased significantly in both groups. There were no significant between-group differences in sarcopenia or body composition. Plasma myostatin levels increased significantly in both groups, with a significant difference in favour of the strength group. Plasma myostatin was significantly positively related to muscle mass and physical performance at baseline, but these relationships were attenuated after 12 months. CONCLUSIONS Exercise training seems to be effective in preventing sarcopenia and maintaining muscle mass in non-dialysis-dependent patients with chronic kidney disease (CKD). However, the role of plasma myostatin on muscle mass and physical performance in patients with CKD warrants further study.
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Affiliation(s)
- Yunan Zhou
- Department of Clinical Sciences Lund, Nephrology, Faculty of Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Matthias Hellberg
- Department of Clinical Sciences Lund, Nephrology, Faculty of Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Thomas Hellmark
- Department of Clinical Sciences Lund, Nephrology, Faculty of Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Peter Höglund
- Department of Laboratory Medicine, Division of Clinical Chemistry & Pharmacology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Naomi Clyne
- Department of Clinical Sciences Lund, Nephrology, Faculty of Medicine, Skåne University Hospital, Lund University, Lund, Sweden
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Zhang NH, Luo R, Cheng YC, Ge SW, Xu G. Leisure-Time Physical Activity and Mortality in CKD: A 1999-2012 NHANES Analysis. Am J Nephrol 2020; 51:919-929. [PMID: 33207339 DOI: 10.1159/000511685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND For patients with CKD, evidence on the optimal dose of physical activity and possible harm with excessive exercise is limited. This study aimed to analyze the dose-response association between leisure-time physical activity (LTPA) and mortality in those with CKD and explore the optimal dose or possible harm associated with increased levels of LTPA. METHODS 4,604 participants with CKD from the 1999 to 2012 National Health and Nutrition Examination Surveys with linked mortality data obtained through 2015 were classified into 6 groups: 0, 1-149, 150-299, 300-599, 600-899, and ≥900 min/week based on the total duration of the self-reported LTPA. Multivariable-adjusted Cox proportional hazards models were used to examine dose-response associations between LTPA and mortality. RESULTS During the median follow-up of 114 months, 1,449 (31%) all-cause deaths were recorded. Compared to the inactive group (0 min/week), we observed a 22% lower risk of all-cause mortality (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.63-0.97) among participants who performed 1-149 min per week for LTPA. The corresponding HRs and 95% CIs for all-cause mortality for 150-299 and 300-599 min/week of LTPA were 0.79 (0.64-0.97) and 0.74 (0.56-0.98). The benefit appeared to reach a threshold of a 43% (HR, 0.57; 95% CI, 0.36-0.91) lower risk of all-cause mortality among individuals performing 600-899 min/week for LTPA. Importantly, for ≥900 min/week of LTPA, the continued benefits were observed (HR, 0.62; 95% CI, 0.44-0.87). CONCLUSION LTPA was associated with lower mortality in those with CKD. The optimal dose was observed at the LTPA level of approximately 600-899 min/week, and there were still benefits rather than the excess risk with LTPA levels as high as ≥900 min/week. Therefore, clinicians should encourage inactive CKD patients to perform LTPA and do not need to discourage CKD patients who already adhere to long-term physical activity.
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Affiliation(s)
- Nan-Hui Zhang
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ran Luo
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi-Chun Cheng
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shu-Wang Ge
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,
| | - Gang Xu
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Syukri M, Virnardo R, Salwani D, Sofyan H. The prevalence and associated factors of metabolic syndrome among patients with end-stage renal failure undergoing hemodialysis in Indonesia. Diabetes Metab Syndr 2020; 14:2069-2072. [PMID: 33120282 DOI: 10.1016/j.dsx.2020.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Various components of Metabolic Syndrome (MetS) have been studied in general population, but few among patients undergoing hemodialysis (HD). This study aims to assess the metabolic profiles and to estimate the prevalence of MetS among patients with End-Stage Renal Failure (ESRF) undergoing HD. METHODS Patients undergoing HD during October 2016-August 2017 in three General Hospitals in Aceh - Indonesia were included in the study. MetS was defined according to the modified NCEP-ATP III criteria for South Asians. RESULTS The overall prevalence of MetS was 50.2%. Male patients have higher MetS prevalence (58.3%) than female (41.7%). MetS was only associated with gender and history of diabetes, and not with other demographic variables. Alteration central obesity was the most common metabolic abnormality among the patients (57.2%), followed by hypertension (30.7%), diabetes (30%), raised triglycerides (27.4%) and reduced HDL (23.7%). Pre-metabolic syndrome was found in 48.3%, leaving only 1.4% of patients free from metabolic abnormality. CONCLUSIONS Half of the patients undergoing HD in Indonesia suffered from MetS and almost half had pre-metabolic syndrome. High rate of metabolic abnormalities in patients with ESRF requires intensive examination and collaboration between nephrologists and endocrinologists to prevent the deterioration of patients' condition during HD.
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Affiliation(s)
- Maimun Syukri
- Department of Internal Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.
| | - Ricky Virnardo
- Department of Internal Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Desi Salwani
- Department of Internal Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Hizir Sofyan
- Department of Statistics, Universitas Syiah Kuala, Banda Aceh, Indonesia
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Effects of exercise on kidney and physical function in patients with non-dialysis chronic kidney disease: a systematic review and meta-analysis. Sci Rep 2020; 10:18195. [PMID: 33097801 PMCID: PMC7585437 DOI: 10.1038/s41598-020-75405-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/14/2020] [Indexed: 12/15/2022] Open
Abstract
Patients with non-dialysis chronic kidney disease (CKD) are at greater risk of early mortality and decreased physical function with an advance in the stage of CKD. However, the effect of exercise in these patients is unclear. This meta-analysis aimed to determine the effects of physical exercise training on the risk of mortality, kidney and physical functions, and adverse events in patients with non-dialysis CKD. The meta-analysis conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and the Cochrane Handbook recommendations. On 16 August 2019, the PubMed, CINAHL, Cochrane Library databases, and Embase were electronically searched, with no restrictions for date/time, language, document type, or publication status, for eligible randomized controlled trials (RCTs) investigating the effects of exercise on mortality and kidney and physical function in patients with non-dialysis CKD. Eighteen trials (28 records), including 848 patients, were analyzed. The effects of exercise on all-cause mortality and estimated glomerular filtration rate were not significantly different from that of usual care. Exercise training improved peak/maximum oxygen consumption compared to usual care. Regular exercise improves physical and walking capacity for patients with non-dialysis CKD. Effect on leg muscle strength was unclear.
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Wilkinson TJ, Watson EL, Vadaszy N, Baker LA, Viana JL, Smith AC. Response of the oxygen uptake efficiency slope to exercise training in patients with chronic kidney disease. Kidney Res Clin Pract 2020; 39:305-317. [PMID: 32550710 PMCID: PMC7530363 DOI: 10.23876/j.krcp.20.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/27/2020] [Accepted: 05/02/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) patients have poor cardiorespiratory fitness. Although cardiopulmonary exercise testing (CPET) is a universal assessment of cardiorespiratory fitness, values taken at 'peak' effort are strongly influenced by motivation and the choice of test endpoint. The oxygen uptake efficiency slope (OUES) integrates cardiovascular, musculoskeletal, and respiratory function into a single index to provide a more pragmatic and safer alternative to maximal testing. No research has explored whether exercise can improve the OUES in CKD patients. METHODS Thirty-two patients with non-dialysis CKD were recruited into a 12-week exercise program consisting of mixed aerobic and resistance training three times a week. CPET was conducted at baseline, and then, following a 6-week control period, at pre- and post-exercise intervention. Direct measurements of oxygen consumption (V̇O2) and ventilatory parameters were collected. The OUES was calculated as the relationship between V̇O2 and the log10 of minute ventilation (V̇E). RESULTS No changes were observed in any variable during the control period, although modest increases in V̇O2peak were observed. No meaningful changes were observed as a result of exercise in any cardiorespiratory value obtained. The OUES calculated at 100%, 90%, 75%, and 50% of exercise duration did not change significantly after 12 weeks of exercise training. CONCLUSION Our results show that 12 weeks of exercise training had no beneficial effects on the OUES, which supports the modest change observed in V̇O2peak. The lack of change in the OUES and other parameters could indicate a dysfunctional cardiorespiratory response to exercise in patients with CKD, likely mediated by dysfunctional peripheral metabolic mechanisms.
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Affiliation(s)
- Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Health Science, University of Leicester, Leicester, UK
| | - Emma L Watson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Noemi Vadaszy
- Leicester Kidney Lifestyle Team, Department of Health Science, University of Leicester, Leicester, UK
| | - Luke A Baker
- Leicester Kidney Lifestyle Team, Department of Health Science, University of Leicester, Leicester, UK
| | - João L Viana
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, ISMAI, Maia, Portugal
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Science, University of Leicester, Leicester, UK
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Xiong Y, Yu Y, Jiang H, Yang Q, Liao R, Wang L, Zhang Z, Fu C, Su B. Visceral Fat Area Is a Better Predictor Than Coronary Artery Calcification Score for Cardiovascular Outcomes and All-Cause Death in Patients on Hemodialysis. J Ren Nutr 2020; 31:306-312. [PMID: 32981835 DOI: 10.1053/j.jrn.2020.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES The aim of this study is to compare the prognostic effects of visceral fat area (VFA) with coronary artery calcification score (CACs) in patients on maintenance hemodialysis. DESIGN AND METHODS In the prospective study with no intervention, clinical characteristics and serum biochemical indexes at baseline for each patient were collected through the electronic medical records. Body composition assessment using bioelectrical impedance analysis, computed tomography examination with the Agatston scoring method, and echocardiographic measurements were performed at enrollment. Primary endpoints included cardiovascular events (CVEs), cardiovascular death (CVD), and all-cause death. RESULTS A total of 97 Chinese patients aged 48 (35-62) years were enrolled from our Hemodialysis Center, of which 61.9% were male and 20.6% had diabetes. The median of VFA and CACs at baseline was 64.5 (43.5-88.7) cm2 and 0.9 (0-467.6), respectively. CVEs occurred in 20 (20.6%) patients during a median follow-up of 26.4 (13-27.7) months. The cardiovascular and all-cause mortality was 8.2% (8 patients) and 11.3% (11 patients), respectively. VFA was associated with CVEs (hazard ratio [HR] = 9.21 for VFA ≥71.3 cm2 vs. VFA <71.3 cm2, P = .017), CVD (HR = 1.11 for 1 cm2 increase, P = .035), and all-cause mortality (HR = 1.08 for 1 cm2 increase, P = .011). Also, VFA was significantly correlated with cardiac structure parameters and the development of left ventricular hypertrophy (odds ratio = 1.02 for 1 cm2 increase, P = .03). Yet, CACs were not correlated with CVEs, CVD, or all-cause mortality. CONCLUSIONS Increased VFA can be used as an independent predictor for CVEs, CVD, and all-cause mortality. The effect VFA exerts on cardiac reconstruction might be the underlying mechanism. Further studies are warranted for the management of VFA in the hemodialysis population.
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Affiliation(s)
- Yuqin Xiong
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Disaster Medicine Center, Sichuan University, Chengdu, People's Republic of China; Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, People's Republic of China
| | - Yang Yu
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Disaster Medicine Center, Sichuan University, Chengdu, People's Republic of China; Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, People's Republic of China
| | - Heng Jiang
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Qinbo Yang
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ruoxi Liao
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Disaster Medicine Center, Sichuan University, Chengdu, People's Republic of China; Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, People's Republic of China
| | - Liya Wang
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Zhuyun Zhang
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Chunlian Fu
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Baihai Su
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Disaster Medicine Center, Sichuan University, Chengdu, People's Republic of China; Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, People's Republic of China.
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Effects of exercise training on renal interstitial fibrosis and renin-angiotensin system in rats with chronic renal failure. J Hypertens 2020; 39:143-152. [PMID: 32833922 DOI: 10.1097/hjh.0000000000002605] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To clarify the mechanisms of the renal protective effects of exercise training, we examined the effects of exercise training on the renal interstitial fibrosis and renin-angiotensin system (RAS) in rats with chronic renal failure. METHODS Six-week-old male Sprague-Dawley rats were divided into three groups: sham operation; 5/6 nephrectomy + sedentary; 5/6 nephrectomy + exercise training. The 5/6 nephrectomy + exercise training group underwent treadmill running (20 m/min, 60 min/day, 5 days/week). After 12 weeks, renal function, histology and protein expression of collagen type I, transforming growth factor-β1 (TGF-β1), matrix metalloproteinase (MMP), tissue inhibitors of metalloproteinase (TIMP) and RAS components in the renal cortex were examined. RESULTS Exercise training ameliorated the 5/6 nephrectomy-induced hypertension, proteinuria, renal dysfunction, glomerular sclerosis and renal interstitial fibrosis. 5/6 Nephrectomy increased the expression of collagen type I, TGF-β1, MMP-2, MMP-9, TIMP-1, angiotensinogen, angiotensin-converting enzyme (ACE), (pro)renin receptor and angiotensin II type 1 receptor, and exercise training inhibited the 5/6 nephrectomy-increased expression of collagen type I, TGF-β1, TIMP-1, angiotensinogen and ACE expressions. 5/6 Nephrectomy decreased the expression of renin, ACE2, angiotensin II type 2 receptor and Mas receptor, and exercise training inhibited the 5/6 nephrectomy-decreased expressions. CONCLUSION These results indicated that exercise training attenuates the progression of glomerular sclerosis and renal interstitial fibrosis in chronic renal failure rats. The renal protective effects of exercise training may be mediated by ameliorating the renal collagen turnover and the exacerbation of renal RAS.
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Lorenz EC, Hickson LJ, Weatherly RM, Thompson KL, Walker HA, Rasmussen JM, Stewart TL, Garrett JK, Amer H, Kennedy CC. Protocolized exercise improves frailty parameters and lower extremity impairment: A promising prehabilitation strategy for kidney transplant candidates. Clin Transplant 2020; 34:e14017. [PMID: 32573816 DOI: 10.1111/ctr.14017] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/28/2020] [Accepted: 06/13/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Frailty and decreased functional status are risk factors for adverse kidney transplant (KT) outcomes. Our objective was to examine the efficacy of an exercise intervention on frailty and decreased functional status in a cohort of patients with advanced chronic kidney disease (CKD). METHODS We conducted a prospective study involving 21 adults with ≥stage 4 CKD who were (a) frail or pre-frail by Fried phenotype and/or (b) had lower extremity impairment [short physical performance battery score ≤10]. The intervention consisted of two supervised outpatient exercise sessions per week for 8 weeks. RESULTS Among our cohort, median participant age was 62 years (interquartile range, 53-67) and 85.7% had been evaluated for KT. Following the study, participants reported satisfaction with the intervention and multiple frailty parameters improved significantly, including fatigue, physical activity, walking time, and grip strength. Lower extremity impairment also improved (90.5%-61.9%, P = .03). No study-related adverse events occurred. CONCLUSIONS Preliminary data from this study suggest that a supervised, outpatient exercise intervention is safe, acceptable, feasible, and associated with improved frailty parameters, and lower extremity function, in patients with advanced CKD. Further studies are needed to confirm these findings and determine whether this prehabilitation strategy improves KT outcomes.
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Affiliation(s)
- Elizabeth C Lorenz
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA.,Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - LaTonya J Hickson
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Renee M Weatherly
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Karin L Thompson
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Heidi A Walker
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Judy M Rasmussen
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tara L Stewart
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - James K Garrett
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hatem Amer
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | - Cassie C Kennedy
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA.,Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Ortega-Pérez de Villar L, Martínez-Olmos FJ, Pérez-Domínguez FDB, Benavent-Caballer V, Montañez-Aguilera FJ, Mercer T, Segura-Ortí E. Comparison of intradialytic versus home-based exercise programs on physical functioning, physical activity level, adherence, and health-related quality of life: pilot study. Sci Rep 2020; 10:8302. [PMID: 32427935 PMCID: PMC7237690 DOI: 10.1038/s41598-020-64372-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 04/15/2020] [Indexed: 02/01/2023] Open
Abstract
Intradialytic exercise (ID) programs are effective and safe for hemodialysis (HD) patients to avoid functional deterioration. However, exercise is not routinely undertaken in most HD units, and we do not know if home-based (HB) programs are as effective as ID programs. The purpose of this study was to compare the effects of 16 weeks of ID exercise versus a HB exercise program for HD patients. A total of 46 patients were randomly assigned to the ID group (n = 24) or HB group (n = 22). They completed a 16-week combined exercise program 3 times/week. We measured physical activity level, physical functioning, depression level, and health-related quality of life at baseline and after 16 weeks. A significant time effect was found in both groups for the physical activity level (p = 0.012). There was also a significant group-time interaction effect for the one-leg standing test (OLST) (p = 0.049) and a significant time effect for the Short Physical Performance Battery (p = 0.013), timed up-and-go test (p = 0.005), sit-to-stand-10 (p = 0.027), right and left hand handgrip (p = 0.044, p < 0.001), one-heel left leg raise (p = 0.019), and 6-minute walking (p = 0.006), depression (p = 0.017). HRQoL remained unchanged. There was no difference between the two interventions on the tested outcomes (besides OLST). Both interventions were associated with positive changes of the physical activity levels and physical function.
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Affiliation(s)
- Lucía Ortega-Pérez de Villar
- Department of Physical Therapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain.
- Department of Physical Therapy, Universidad Europea de Valencia, Valencia, Spain.
| | | | | | - Vicent Benavent-Caballer
- Department of Physical Therapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | | | - Tom Mercer
- Centre for Health, Activity and Rehabilitation Research School of Health Sciences, Queen Margaret University, Musselburgh, UK
| | - Eva Segura-Ortí
- Department of Physical Therapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
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Villanego F, Naranjo J, Vigara LA, Cazorla JM, Montero ME, García T, Torrado J, Mazuecos A. Impact of physical exercise in patients with chronic kidney disease: Sistematic review and meta-analysis. Nefrologia 2020; 40:237-252. [PMID: 32305232 DOI: 10.1016/j.nefro.2020.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/25/2019] [Accepted: 01/19/2020] [Indexed: 01/22/2023] Open
Abstract
Physical exercise may offer multiple benefits to patients with chronic kidney disease (CKD). However, it was not traditionally recommended because of the possibility of impairing renal function and increasing proteinuria. The objective of this study is to review the clinical trials on physical exercise in patients with CKD and describe its effect on the progression of kidney disease and other factors associated. Randomized clinical trials (RCT) comparing an intervention that included an exercise component with a control group without physical exercise in non-dialysis patients with CKD from 2007 to 2018 in English and Spanish were included. PubMed, Scopus, Embase, Ovid (Medline) and PEDro databases were used for the search. Effects of physical exercise were summarized by the standardized mean difference (SMD). No differences were found in glomerular filtration rate or proteinuria between the intervention group and the control group: SMD -0.3 (P=.81); SMD 26.6 (P=.82). Positive effects were obtained on peak oxygen consumption: SMD 2.5 (P<.001), functional capacity: SMD 56.6 (P<.001), upper limb strength: SMD 6.8 (P<.001) and hemoglobin: SMD 0.3 (P=.003). An improvement on the quality of life was also evident using the KDQOL-36 survey: SMD 3.56 (P=.02) and the SF-36 survey: SMD 6.66 (P=.02). In conclusion, the practice of low-intensity physical exercise routinely has no negative impact on renal function. On the contrary, it improves aerobic and functional capacity, impacting positively on the quality of life.
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Affiliation(s)
| | - Javier Naranjo
- Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Luis Alberto Vigara
- Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Juan Manuel Cazorla
- Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Maria Elisa Montero
- Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Teresa García
- Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Julia Torrado
- Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, España
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Zhang NH, Luo R, Cheng YC, Ge SW, Xu G. Leisure-Time Physical Activity and Mortality in CKD: A 1999–2012 NHANES Analysis. Am J Nephrol 2020. [DOI: 10.1159/000511685
expr 827068279 + 951355476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
<b><i>Background:</i></b> For patients with CKD, evidence on the optimal dose of physical activity and possible harm with excessive exercise is limited. This study aimed to analyze the dose-response association between leisure-time physical activity (LTPA) and mortality in those with CKD and explore the optimal dose or possible harm associated with increased levels of LTPA. <b><i>Methods:</i></b> 4,604 participants with CKD from the 1999 to 2012 National Health and Nutrition Examination Surveys with linked mortality data obtained through 2015 were classified into 6 groups: 0, 1–149, 150–299, 300–599, 600–899, and ≥900 min/week based on the total duration of the self-reported LTPA. Multivariable-adjusted Cox proportional hazards models were used to examine dose-response associations between LTPA and mortality. <b><i>Results:</i></b> During the median follow-up of 114 months, 1,449 (31%) all-cause deaths were recorded. Compared to the inactive group (0 min/week), we observed a 22% lower risk of all-cause mortality (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.63–0.97) among participants who performed 1–149 min per week for LTPA. The corresponding HRs and 95% CIs for all-cause mortality for 150–299 and 300–599 min/week of LTPA were 0.79 (0.64–0.97) and 0.74 (0.56–0.98). The benefit appeared to reach a threshold of a 43% (HR, 0.57; 95% CI, 0.36–0.91) lower risk of all-cause mortality among individuals performing 600–899 min/week for LTPA. Importantly, for ≥900 min/week of LTPA, the continued benefits were observed (HR, 0.62; 95% CI, 0.44–0.87). <b><i>Conclusion:</i></b> LTPA was associated with lower mortality in those with CKD. The optimal dose was observed at the LTPA level of approximately 600–899 min/week, and there were still benefits rather than the excess risk with LTPA levels as high as ≥900 min/week. Therefore, clinicians should encourage inactive CKD patients to perform LTPA and do not need to discourage CKD patients who already adhere to long-term physical activity.
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Watson EL, Baker LA, Wilkinson TJ, Gould DW, Graham‐Brown MP, Major RW, Ashford RU, Philp A, Smith AC. Reductions in skeletal muscle mitochondrial mass are not restored following exercise training in patients with chronic kidney disease. FASEB J 2019; 34:1755-1767. [DOI: 10.1096/fj.201901936rr] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Emma L. Watson
- Department of Cardiovascular Sciences University of Leicester Leicester UK
| | - Luke A. Baker
- Department of Health Sciences University of Leicester Leicester UK
| | | | - Douglas W. Gould
- Department of Cardiovascular Sciences University of Leicester Leicester UK
- Intensive Care National Audit and Research Centre London UK
| | - Matthew P.M. Graham‐Brown
- Department of Cardiovascular Sciences University of Leicester Leicester UK
- John Walls Renal Unit University Hospitals of Leicester NHS Trust Leicester UK
- National Centre for Sport and Exercise Medicine School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
| | - Rupert W. Major
- Department of Health Sciences University of Leicester Leicester UK
- John Walls Renal Unit University Hospitals of Leicester NHS Trust Leicester UK
| | - Robert U. Ashford
- Leicester Orthopaedics University Hospitals of Leicester Leicester UK
- Leicester Cancer Research Centre University of Leicester Leicester UK
| | - Andrew Philp
- Garvan Institute of Medical Research Darlinghurst NSW Australia
- UNSW Medicine UNSW Sydney Sydney NSW Australia
| | - Alice C. Smith
- Department of Health Sciences University of Leicester Leicester UK
- John Walls Renal Unit University Hospitals of Leicester NHS Trust Leicester UK
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Body Composition and Biochemical Markers of Nutrition in Non-dialysis-Dependent Chronic Kidney Disease Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1251:81-89. [PMID: 31745729 DOI: 10.1007/5584_2019_444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The aim of this study was to examine the body composition in stages 3b to 5 of chronic kidney disease. There were 149 patients included in the study, with the mean age of 65.5 ± 16.5 years, body mass index (BMI) of 29.4 ± 5.6 kg/m2, and estimated glomerular filtration rate (eGFR) of 23.2 ± 9.3/min/1.73m2. They remained with dialysis. Body composition was measured using bioimpedance spectroscopy, and handgrip strength was measured with a hydraulic dynamometer. The main biochemical markers assessed consisted of serum protein, albumin, prealbumin, high-sensitivity C-reactive protein (hsCRP), and interleukin (IL)-6 content. We found that 39% of patients were overweight and 41% were obese. Obesity was more prevalent in stage 3b of chronic kidney disease than in stages 4-5 in women and in patients older than 60 years of age. Thirty-eight percent of the study population were sarcopenic, of whom 20% presented a sarcopenic obesity phenotype. There were significant associations between lean tissue index (LTI) and serum prealbumin content and handgrip strength. Fat tissue index (FTI) was associated and hsCRP, serum protein, body mass index (BMI), waist-hip ratio, and waist-to-height ratio. There were inverse associations between FTI-LTI and LTI-age. We conclude that the prevalence of obesity in non-dialysis-dependent patients with chronic kidney disease is higher than that in the general population. Earlier stages of chronic kidney disease are associated with a higher prevalence of obesity.
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Zhang L, Wang Y, Xiong L, Luo Y, Huang Z, Yi B. Exercise therapy improves eGFR, and reduces blood pressure and BMI in non-dialysis CKD patients: evidence from a meta-analysis. BMC Nephrol 2019; 20:398. [PMID: 31664943 PMCID: PMC6821004 DOI: 10.1186/s12882-019-1586-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 10/13/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) have a high prevalence of cardiovascular diseases, which often lead to physical inactivity that correlates with CKD exacerbation. The benefits of regular exercise to cardiovascular health have been well established in healthy population and highly suggestive in patients with CKD. To further strengthen the evidence base for the management of CKD, this meta-analysis was performed to systematically evaluate the effects of exercise therapy on renal function, blood pressure, blood lipid and body mass index (BMI) in non-dialysis CKD patients. METHODS This meta-analysis was conducted following a previous protocol. Randomized controlled trials (RCTs) examining the effects of exercise therapy in non-dialysis CKD patients were searched in Pubmed, Embase, Cochrane Library, and three major Chinese biomedical databases (CNKI, WANGFANG and VIP) from their start date to October 30th, 2018. The Cochrane systematic review methods were applied for quality assessment and data extraction, and Revman version 5.3 was used for systematic review and meta-analysis. RESULTS 13 RCTs, representing 421 patients with non-dialysis CKD, were included in this meta-analysis. Compared to the controls, exercise therapy brought an increase in eGFR (MD = 2.62, 95% CI:0.42 to 4.82, P = 0.02, I2 = 22%), and decreases in systolic blood pressure (SBP) (MD = -5.61, 95% CI:-8.99 to - 2.23, P = 0.001, I2 = 44%), diastolic blood pressure (DBP) (MD = -2.87, 95% CI:-3.65 to - 2.08, P < 0.00001, I2 = 16%) and BMI (MD = -1.32, 95% CI:-2.39 to - 0.25, P = 0.02, I2 = 0%) in non-dialysis CKD patients. Exercise therapy of short-term (< 3 months) decreased triglyceride (TG) level (P = 0.0006). However, exercise therapy did not significantly affect serum creatinine (SCr), total cholesterol (TC), high density lipoprotein (HDL) or low density lipoprotein (LDL) in non-dialysis CKD patients. CONCLUSION Exercise therapy could benefit non-dialysis CKD patients by increasing eGFR while reducing SBP, DBP and BMI. Additionally, short-term intervention of exercise could decrease TG.
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Affiliation(s)
- Lijun Zhang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Yangyang Wang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Lianlian Xiong
- Department of Nephrology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Yanfang Luo
- Department of Nephrology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Zhijun Huang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bin Yi
- Department of Nephrology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China.
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Luan X, Tian X, Zhang H, Huang R, Li N, Chen P, Wang R. Exercise as a prescription for patients with various diseases. JOURNAL OF SPORT AND HEALTH SCIENCE 2019; 8:422-441. [PMID: 31534817 PMCID: PMC6742679 DOI: 10.1016/j.jshs.2019.04.002] [Citation(s) in RCA: 206] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/12/2019] [Accepted: 03/01/2019] [Indexed: 05/18/2023]
Abstract
A growing understanding of the benefits of exercise over the past few decades has prompted researchers to take an interest in the possibilities of exercise therapy. Because each sport has its own set of characteristics and physiological complications that tend to occur during exercise training, the effects and underlying mechanisms of exercise remain unclear. Thus, the first step in probing the effects of exercise on different diseases is the selection of an optimal exercise protocol. This review summarizes the latest exercise prescription treatments for 26 different diseases: musculoskeletal system diseases (low back pain, tendon injury, osteoporosis, osteoarthritis, and hip fracture), metabolic system diseases (obesity, type 2 diabetes, type 1 diabetes, and nonalcoholic fatty liver disease), cardio-cerebral vascular system diseases (coronary artery disease, stroke, and chronic heart failure), nervous system diseases (Parkinson's disease, Huntington's disease, Alzheimer's disease, depression, and anxiety disorders), respiratory system diseases (chronic obstructive pulmonary disease, interstitial lung disease, and after lung transplantation), urinary system diseases (chronic kidney disease and after kidney transplantation), and cancers (breast cancer, colon cancer, prostate cancer, and lung cancer). Each exercise prescription is displayed in a corresponding table. The recommended type, intensity, and frequency of exercise prescriptions are summarized, and the effects of exercise therapy on the prevention and rehabilitation of different diseases are discussed.
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Affiliation(s)
- Xin Luan
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Xiangyang Tian
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Haixin Zhang
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
- Department of Sport, Huainan Normal University, Huainan 232038, China
| | - Rui Huang
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Na Li
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Peijie Chen
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
- Corresponding authors.
| | - Ru Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
- Corresponding authors.
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Impact of Body Composition on Surgical Outcome in Rectal Cancer Patients, a Retrospective Cohort Study. World J Surg 2019; 43:1370-1376. [PMID: 30719554 DOI: 10.1007/s00268-019-04925-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Obesity is becoming a bigger health problem every year. Current research shows that the obesity-related metabolic problems are strongly associated with visceral fat and not subcutaneous fat. Visceral obesity (VO) is associated with a worse postoperative outcome in multiple fields of abdominal surgery. On the other hand, muscle mass is related to better postoperative outcome. In rectal cancer patients, we studied the influence of visceral obesity and muscle mass on postoperative complications. METHODS The visceral fat area (VFA) and skeletal muscle area (SMA) were determined on preoperative CT scans in 406 patients. The preoperative comorbidity, per-operative outcome and postoperative complications were extracted retrospectively from the patient files. VO was defined as a VFA > 100 cm2. Correlations between body composition, postoperative complications and LOS were studied. RESULTS In our study, 67% of the patients were classified as visceral obese. Mean body mass index (BMI) was higher in the VO group (26.6 ± 3.5 vs 23.5 ± 2.8; p < 0.001). Visceral obese patients had a higher prevalence of cardiac comorbidity (29% vs 13% p = 0.001), hypertension (36% vs 20% p = 0.002) and diabetes mellitus (16% vs 5% p = 0.002). In addition, VO patients had more operative blood loss (431 vs 310 mL; p = 0.008), longer operating time (166 vs 149 min p = 0.003) and more wound infections (14% vs 8% p = 0.048). Visceral obesity was associated with more complications (OR: 1.63 p = 0.043) and longer LOS (risk estimate: 1.18 p = 0.009). CONCLUSION VO patients more often had a history of cardiac disease, hypertension and diabetes mellitus. Visceral obesity correlated with a worse outcome after surgery for rectal cancer.
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Yamagata K, Hoshino J, Sugiyama H, Hanafusa N, Shibagaki Y, Komatsu Y, Konta T, Fujii N, Kanda E, Sofue T, Ishizuka K, Kitagawa M, Kono K, Hinamoto N, Miyai T, Koike K, Toda S, Hasegawa J, Yamanouchi M, Yoshimura R, Ishii R, Goto S, Kawarazaki H, Takase K, Taki F, Matsumura M, Raita Y, Sakurai S, Shimizu T, Yamanoto S, Kawaguchi T, Oguchi H, Tsujita M, Yazawa M, Uchida A, Ando Y, Kaneko S, Matsunaga A, Harada T, Ito O, Kohzuki M. Clinical practice guideline for renal rehabilitation: systematic reviews and recommendations of exercise therapies in patients with kidney diseases. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0209-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Zelko A, Skoumalova I, Kolarcik P, Rosenberger J, Rabajdova M, Marekova M, Geckova AM, van Dijk JP, Reijneveld SA. The effects of intradialytic resistance training on muscle strength, psychological well-being, clinical outcomes and circulatory micro-ribonucleic acid profiles in haemodialysis patients: Protocol for a quasi-experimental study. Medicine (Baltimore) 2019; 98:e15570. [PMID: 31083229 PMCID: PMC6531031 DOI: 10.1097/md.0000000000015570] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Intradialytic resistance training (IRT) protects patients' muscle mass and functions against protein-energy wasting, malnutrition and cachexia. However, the evidence of the effects of such an intervention in haemodialysis patients is limited and not conclusive. To improve the applicability of such interventions, we need a better understanding of molecular, functional and psycho-social adaptation in dialysed patients following a physical training. Therefore, the aim of this study is to investigate the effects of IRT on lower extremity muscle functions, quality of life, and anxiety and depression, clinical outcomes and circulatory micro-ribonucleic acid (miRNA) profiles in patients on chronic haemodialysis therapy. METHODS We will perform a quasi-experimental study in 3 dialysis centres. Patients will be recruited via their nephrologists and will be allocated to an experimental and a control group based on the location of the patients' dialysis centre. Patients allocated to the experimental group will undergo a 12-week IRT, while the control group will remain physically inactive during dialysis. The primary outcome is the change in the maximal force produced during an isometric contraction of lower extremity muscles. Secondary outcomes regard quality of life, anxiety and depression, clinical outcomes and circulatory miRNA profiles. Patients' level of health literacy defined as the ability to get and understand health information will be also measured in the study as a potential modifier of effects. DISCUSSION This quasi-experimental study can add in an important way to our understanding of the effects of resistance training on dialysis patients' muscle strength, quality of life and disease-specific outcomes.
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Affiliation(s)
- Aurel Zelko
- Institute of Physical Education and Sport, Pavol Jozef Safarik University, Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Ivana Skoumalova
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Department of Health Psychology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein, Groningen, Netherlands
| | - Peter Kolarcik
- Department of Health Psychology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Olomouc University Society and Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
| | - Jaroslav Rosenberger
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Department of Health Psychology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Olomouc University Society and 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
| | - Miroslava Rabajdova
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Maria Marekova
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Andrea Madarasova Geckova
- Department of Health Psychology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Olomouc University Society and Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
| | - 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, Hanzeplein, Groningen, Netherlands
- Olomouc University Society and Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
| | - Sijmen A. Reijneveld
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein, Groningen, Netherlands
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Uchiyama K, Washida N, Morimoto K, Muraoka K, Kasai T, Yamaki K, Miyashita K, Wakino S, Itoh H. Home-based Aerobic Exercise and Resistance Training in Peritoneal Dialysis Patients: A Randomized Controlled Trial. Sci Rep 2019; 9:2632. [PMID: 30796338 PMCID: PMC6385506 DOI: 10.1038/s41598-019-39074-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/16/2019] [Indexed: 01/08/2023] Open
Abstract
Potential effects of aerobic and resistance training in peritoneal dialysis (PD) patients have been partially elucidated. We investigated effects of a home-based exercise program on physical functioning and health-related quality of life (HRQOL) in PD patients. Patients were randomly assigned to exercise (n = 24) and usual care (n = 23) groups. The exercise patients performed aerobic exercise thrice weekly and resistance training twice weekly at home for 12 weeks. The usual care patients received no specific intervention. The distance in incremental shuttle walking test significantly improved in the exercise group compared with the usual care group (P = 0.02). Among the HRQOL subscales assessed using the Kidney Disease Quality of Life-Short Form questionnaire, kidney disease component summary (P = 0.03), physical role functioning (P = 0.01), emotional role functioning (P < 0.01), and role/social component summary (P < 0.01) significantly improved in the exercise group. Moreover, serum albumin was significantly maintained in the exercise group (P = 0.03). There were no reported adverse events associated with the intervention. To our knowledge, this is the first randomized controlled trial to indicate the beneficial effects of a 12-week home-based exercise program exclusively in PD patients.
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Affiliation(s)
- Kiyotaka Uchiyama
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Naoki Washida
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Nephrology, International University of Health and Welfare School of Medicine, 4-3, Kozunomori, Narita, Chiba, 286-8686, Japan
| | - Kohkichi Morimoto
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kaori Muraoka
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takahiro Kasai
- Department of Nephrology, International University of Health and Welfare School of Medicine, 4-3, Kozunomori, Narita, Chiba, 286-8686, Japan
| | - Kentaro Yamaki
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazutoshi Miyashita
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shu Wakino
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Itoh
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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The effect of exercise on blood pressure in chronic kidney disease: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2019; 14:e0211032. [PMID: 30726242 PMCID: PMC6364898 DOI: 10.1371/journal.pone.0211032] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/07/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Management of hypertension in chronic kidney disease (CKD) remains a major challenge. We conducted a systematic review to assess whether exercise is an effective strategy for lowering blood pressure in this population. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS We searched MEDLINE, EMBASE, the Cochrane Library, CINAHL and Web of Science for randomized controlled trials (RCTs) that examined the effect of exercise on blood pressure in adults with non-dialysis CKD, stages 3-5. Outcomes were non-ambulatory systolic blood pressure (primary), other blood pressure parameters, 24-hour ambulatory blood pressure, pulse-wave velocity, and flow-mediated dilatation. Results were summarized using random effects models. RESULTS Twelve studies with 505 participants were included. Ten trials (335 participants) reporting non-ambulatory systolic blood pressure were meta-analysed. All included studies were a high risk of bias. Using the last available time point, exercise was not associated with an effect on systolic blood pressure (mean difference, MD -4.33 mmHg, 95% confidence interval, CI -9.04, 0.38). The MD after 12-16 and 24-26 weeks of exercise was significant (-4.93 mmHg, 95% CI -8.83, -1.03 and -10.94 mmHg, 95% CI -15.83, -6.05, respectively) but not at 48-52 weeks (1.07 mmHg, 95% CI -6.62, 8.77). Overall, exercise did not have an effect on 24-hour ambulatory blood pressure (-5.40 mmHg, 95% CI -12.67, 1.87) or after 48-52 weeks (-7.50 mmHg 95% CI -20.21, 5.21) while an effect was seen at 24 weeks (-18.00 mmHg, 95% CI -29.92, -6.08). Exercise did not have a significant effect on measures of arterial stiffness or endothelial function. CONCLUSION Limited evidence from shorter term studies suggests that exercise is a potential strategy to lower blood pressure in CKD. However, to recommend exercise for blood pressure control in this population, high quality, longer term studies specifically designed to evaluate hypertension are needed.
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Hellberg M, Höglund P, Svensson P, Clyne N. Comparing effects of 4 months of two self-administered exercise training programs on physical performance in patients with chronic kidney disease: RENEXC - A randomized controlled trial. PLoS One 2018; 13:e0207349. [PMID: 30571753 PMCID: PMC6301660 DOI: 10.1371/journal.pone.0207349] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 10/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background Exercise training is recommended to patients with chronic kidney disease (CKD). However, the level of evidence is still low. This randomized controlled trial (RCT) compared two different and self-administered exercise training programs in a representative CKD population. Methods This single centre RCT included 151 non-dialysis dependent CKD patients, irrespective of age and comorbidity. Self-administered exercise training of 150 minutes per week was prescribed for 4 months and consisted of 60 minutes endurance training in combination with 90 minutes of either strength or balance training (strength versus balance group). Overall endurance (6-minute walk-test (6-MWT), stair climbing), muscular endurance (30-seconds sit-to-stand (30-STS), heel rises and toe lifts, handgrip (HGS) and isometric quadriceps (IQS) strength, balance (functional reach (FR) and Berg´s balance scale (BBS)) and fine motor skills (Moberg´s picking up test (MPUT)) were measured at baseline and after 4 months. Intention to treat analyses with mixed models was used. Results 53 women and 98 men, mean age 66 ± 14: range 19 to 87 years, eGFR 20 ± 7: range 8 to 48 ml/min/1.73m2 participated. The strength group (n = 76) improved significantly in 6-MWT, stair climbing, 30-STS, heel rises right and left, toe lifts right, IQS right and left, and MPUT with closed eyes with the right and left hand. The balance group (n = 75) improved significantly in heel rises right and left, IQS left, BBS and left-handed MPUT with open and closed eyes. A significant effect between the groups was found for IQS right. Conclusions Two different exercise training programs, consisting of endurance in combination with either strength or balance exercise training, improved or maintained overall endurance, muscular strength and endurance, balance and fine motor skills after 4 months of 150 minutes/week self-administered exercise training in a representative CKD population, regardless of age and comorbidity.
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Affiliation(s)
- Matthias Hellberg
- Department of Nephrology, Institution of Clinical Sciences, Faculty of Medicine, Lund University, Skåne University Hospital, Lund, Sweden
- * E-mail:
| | - Peter Höglund
- Department of Clinical Chemistry and Pharmacology, Institution of Laboratory Medicine, Faculty of Medicine, Lund University, Skåne University Hospital, Lund, Sweden
| | - Philippa Svensson
- Department of Nephrology, Institution of Clinical Sciences, Faculty of Medicine, Lund University, Skåne University Hospital, Lund, Sweden
| | - Naomi Clyne
- Department of Nephrology, Institution of Clinical Sciences, Faculty of Medicine, Lund University, Skåne University Hospital, Lund, Sweden
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Fernandes AS, Ramos CI, Nerbass FB, Cuppari L. Diet Quality of Chronic Kidney Disease Patients and the Impact of Nutritional Counseling. J Ren Nutr 2018; 28:403-410. [DOI: 10.1053/j.jrn.2017.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 11/11/2022] Open
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