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Nogueira-Pérez Á, Ruiz-López-Alvarado P, Barril-Cuadrado G. Can Functional Motor Capacity Influence Mortality in Advanced Chronic Kidney Disease Patients? Nutrients 2024; 16:2689. [PMID: 39203824 PMCID: PMC11356919 DOI: 10.3390/nu16162689] [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: 06/15/2024] [Revised: 07/12/2024] [Accepted: 08/09/2024] [Indexed: 09/03/2024] Open
Abstract
Alterations in the body's nutritional status or composition may be observed as the kidney disease advances, which could influence the kidney's functional capacity and, consequently, could increase the risk of mortality. The aim of the study is to determine the influence of functional capacity on mortality assessed by different functional tests in patients with advanced chronic kidney disease (ACKD). A prospective observational study was designed, which included 225 patients followed for 8 years in a CKD clinic. The study assessed functional capacity by using a range of tests, which included the Short Physical Performance Battery, the 6 minutes walking gait test, the timed up and go, and the four versions of the sit-to-stand test. Additionally, body composition and nutritional conditions were considered, taking into consideration various biochemical indicators such as albumin, prealbumin, c-reactive protein (CRP), lymphocytes, and transferrin, muscle strength, comorbidity, and frailty. The relationship between functionality and all-cause mortality was investigated using a Cox proportional hazard model. A total of fifty patients died during the duration of the study. Patients who performed worse on the function and muscle strength tests showed a worse body composition and nutritional status, and exhibited a reduced life expectancy. Inflammation (CRP) was associated with an increased risk of mortality (model 1: hazard ratio (HR) = 1.246; 95% confidence interval (95% CI = 1.014-1.531; model 2: HR = 1.333; 95% CI = 1.104-1.610). Good functional capacity as determined by the SPPB test decreased the risk of mortality (model 1: HR = 0.764; 95% CI = 0.683-0.855; model 2 HR = 0.778; 95% CI = 0.695-0.872). Cut-off points of maximum sensitivity and specificity for mortality were obtained with different tests. The study demonstrated that functional capacity influences mortality in patients with ACKD, being higher in those patients with impaired functionality regardless of the test used, although the SPPB allows a larger number of patients to be assessed. Therefore, it is essential to incorporate the assessment of functionality into the comprehensive care of patients with CKD.
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Affiliation(s)
- Ángel Nogueira-Pérez
- Avericum, 35220 Las Palmas, Spain
- Department of Nephrology, Hospital Universitario de la Princesa, 28006 Madrid, Spain;
| | | | - Guillermina Barril-Cuadrado
- Department of Nephrology, Hospital Universitario de la Princesa, 28006 Madrid, Spain;
- Fundación Investigaciones Bioimédicas, 28290 Las Rozas de Madrid, Spain
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Sato T, Ono M, Kawamura K, Naganuma W, Shishito N, Morishita S, Sasamoto Y, Kohzuki M. Impact of moderate to vigorous intensity physical activity on change in renal function in patients after acute myocardial infarction. Heart Vessels 2024; 39:393-403. [PMID: 38189923 DOI: 10.1007/s00380-023-02354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/27/2023] [Indexed: 01/09/2024]
Abstract
Acute myocardial infarction (AMI) is associated with a decline in renal function. This study aimed to investigate the impact of engaging in moderate to vigorous intensity physical activity (MVPA) for more than 30 min per day on changes in renal function during the first 3 months after AMI onset. A prospective, observational study was conducted, enrolling 87 patients (75 men; average age, 65.2 ± 12.5 years) who had experienced AMI. The cystatin C-based estimated glomerular filtration rate (eGFRcys) was collected at and 3 months after discharge. Daily MVPA was measured using triaxial accelerometers at a threshold of 3.0 Metabolic equivalent of the task for 3 months. Generalized estimating equations (GEE) were applied to evaluate the longitudinal association between the number of days per week of MVPA for 30 min or more and within-patient changes in eGFRcys. The patients were categorized into three groups based on their MVPA engagement days: 0 days (n = 20), 1-2 days (n = 14), and 3-7 days (n = 53) groups. After adjusting for potential confounding variables, GEE analysis revealed that the eGFRcys slope over 3 months was significantly higher in the 3-7 days group than in 0 days group (B = 2.9, (95% confidence interval: 1.5-4.2), p < 0.001). Similar results were obtained when MVPA time thresholds were set to 40 and 60 min. These findings suggest a significant positive effect of engaging in MVPA for 30 min or more for 3-7 days per week in the improvement of renal function after AMI onset.
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Affiliation(s)
- Toshimi Sato
- Department of Physical Therapy, Fukushima Medical University School of Health Sciences, 10-6, Sakaemachi, Fukushima, 960-8516, Japan.
| | - Masahiro Ono
- Department of Cardiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Keiichi Kawamura
- Department of Cardiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Wakako Naganuma
- Department of Cardiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Namiko Shishito
- Department of Cardiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Shinichiro Morishita
- Department of Physical Therapy, Fukushima Medical University School of Health Sciences, 10-6, Sakaemachi, Fukushima, 960-8516, Japan
| | - Yuichiro Sasamoto
- Department of Rehabilitation, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Masahiro Kohzuki
- Yamagata Prefectural University of Health Sciences, Yamagata, Japan
- Tohoku University Graduate School of Medicine, Sendai, Japan
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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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Mroué A, Roueff S, Vanorio-Vega I, Lazareth H, Kovalska O, Flahault A, Tuppin P, Thervet E, Iliou MC. Benefits of Cardiac Rehabilitation in Cardio-Renal Patients With Heart Failure With Reduced Ejection Fraction. J Cardiopulm Rehabil Prev 2023; 43:444-452. [PMID: 36892848 DOI: 10.1097/hcr.0000000000000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
PURPOSE Chronic kidney disease (CKD) is common in heart failure (HF). Chronic kidney disease often worsens the prognosis and impairs the management of patients with HF. Chronic kidney disease is frequently accompanied by sarcopenia, which limits the benefits of cardiac rehabilitation (CR). The aim of this study was to evaluate the impact of CR on cardiorespiratory fitness in HF patients with reduced ejection fraction (HFrEF) according to the CKD stage. METHODS We conducted a retrospective study including 567 consecutive patients with HFrEF, who underwent a 4-wk CR program, and who were evaluated by cardiorespiratory exercise test before and after the program. Patients were stratified according to their estimated glomerular filtration rate (eGFR). We performed multivariate analysis looking for factors associated with an improvement of 10% in peak oxygen uptake (V˙ o2peak ). RESULTS Thirty-eight percent of patients had eGFR <60 mL/min/1.73m². With decreasing eGFR, we observed deterioration in V˙ o2peak , first ventilatory threshold (VT1) and workload and an increase in brain natriuretic peptide levels at baseline. After CR, there was an improvement in V˙ O2peak (15.3 vs 17.8 mL/kg/min, P < .001), VT1 (10.5 vs 12.4 mL/kg/min, P < .001), workload (77 vs 94 W, P < .001), and brain natriuretic peptide (688 vs 488 pg/mL, P < .001). These improvements were statistically significant for all stages of CKD. In a multivariate analysis predicting factors associated with V˙ o2peak improvement, renal function did not interfere with results. CONCLUSIONS Cardiac rehabilitation is beneficial in patients with HFrEF with CKD regardless of CKD stage. The presence of CKD should not prevent the prescription of CR in patients with HFrEF.
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Affiliation(s)
- Ahmad Mroué
- Department of Nephrology, Georges Pompidou European Hospital, APHP, Paris, France (Drs Mroué, Roueff, Lazareth, Flahault, and Thervet); Direction de la stratégie des études et des statistiques, Caisse nationale de l'assurance maladie (CNAM), Paris, France (Drs Vanorio-Vega and Tuppin); Agence de la biomédecine, Saint-Denis, France (Dr Vanorio-Vega); Université Paris Cité, Paris, France (Drs Lazareth, Flahault, and Thervet); and Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, APHP, Paris, France (Drs Kovalska and Iliou)
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Sato T, Morishita S, Ono M, Funami Y, Hayao K, Kusano D, Kohzuki M. Peak exercise oxygen uptake and changes in renal function in patients after acute myocardial infarction. Heart Lung 2023; 57:277-282. [PMID: 36332352 DOI: 10.1016/j.hrtlng.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of exercise tolerance on renal function change after acute myocardial infarction (AMI) is not clear. OBJECTIVES The present study aimed to elucidate the effect of peak exercise oxygen uptake (VO2) levels on longitudinal changes in renal function up to 1 year after onset of AMI. METHODS This retrospective longitudinal study enrolled 198 AMI patients. Symptom-limited cardiopulmonary exercise testing was performed at completion of early Phase II cardiac rehabilitation, and peak VO2 levels were defined as the primary exposure factor. The estimated glomerular filtration rates (eGFRs) at baseline, 3 months, 6 months and 1 year were collected. Generalized estimating equation (GEE) models were used to test the longitudinal effect of peak VO2 levels on within-patient changes in eGFR. RESULTS Patients were stratified into tertile groups (Low group, 12.3 ± 1.3 mL/kg/min; Mid group, 15.3 ± 0.7 mL/kg/min; and High group, 19.1 ± 2.3 mL/kg/min) according to peak VO2 levels. The slopes of eGFR over 1 year in the Low (p = 0.024) and Mid groups (p = 0.037) were lower compared to the High group. The Low group had a significantly higher odds ratio of experiencing rapid renal function decline than the High group (odds ratio, 2.87; p = 0.012). CONCLUSIONS There was a significant effect of lower peak VO2 on rapid decline in renal function after AMI. Our findings suggest that the coexistence of exercise intolerance may be a novel risk factor for rapid decline in renal function after AMI.
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Affiliation(s)
- Toshimi Sato
- Department of Rehabilitation, Southern Tohoku General Hospital, Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama, Fukushima 963-8563, Japan.
| | - Shinichiro Morishita
- Department of Physical Therapy, Fukushima Medical University School of Health Sciences, Fukushima, Japan
| | - Masahiro Ono
- Department of Cardiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Yoshinari Funami
- Department of Rehabilitation, Southern Tohoku General Hospital, Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama, Fukushima 963-8563, Japan
| | - Keishi Hayao
- Department of Rehabilitation, Southern Tohoku General Hospital, Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama, Fukushima 963-8563, Japan
| | - Daichi Kusano
- Department of Rehabilitation, Southern Tohoku General Hospital, Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama, Fukushima 963-8563, Japan
| | - Masahiro Kohzuki
- Yamagata Prefectural University of Health Sciences, Yamagata, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan
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Sommers N, Berger M, Rubenstein JC, Roth J, Pan A, Thompson C, Widlansky ME. Onset of the COVID-19 pandemic reduced active time in patients with implanted cardiac devices. Eur Rev Aging Phys Act 2022; 19:26. [PMID: 36324065 PMCID: PMC9628136 DOI: 10.1186/s11556-022-00305-0] [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: 01/28/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Physical inactivity and sedentary behavior are modifiable risk factors for chronic disease and all-cause mortality that may have been negatively impacted by the COVID-19 shutdowns. METHODS Accelerometry data was retrospectively collected from 332 permanent pacemaker (PPM) and 244 implantable cardiac defibrillation (ICD) patients for 6 time points: March 15-May 15, 2020 (pandemic period), January 1-March 14, 2020, October 1-December 31, 2019, March 15-May 15, 2019, January 1-March 14, 2019, and October 1-December 31, 2018. Paired t-tests, with Bonferroni correction, were used to compare time periods. RESULTS Activity significantly decreased during the pandemic period compared to one year prior by an average of 0.53 ± 1.18h/day (P < 0.001) for PPM patients and 0.51 ± 1.2h/day (P < 0.001) for ICD patients. Stratification of subjects by active time (< 2 versus ≥ 2h/day) showed patients with < 2h, particularly those with ICDs, had modestly greater activity reductions with the pandemic onset. Logistical regression analyses suggest a trend toward a greater reduction in active time at the onset of the pandemic and an increased risk of hospital or emergency department (ED) admission for PPM patients, but not ICD patients. CONCLUSION The onset of the pandemic in the United States was associated with a significant drop in PPM and ICD patient active hours that was modestly more pronounced in less active patients and cannot be explained by one year of aging or seasonal variation. If sustained, these populations may experience excess cardiovascular morbidity.
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Affiliation(s)
- Nicholas Sommers
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - Marcie Berger
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - Jason C. Rubenstein
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - James Roth
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - Amy Pan
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - Colton Thompson
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - Michael E. Widlansky
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA ,grid.30760.320000 0001 2111 8460Division of Cardiovascular Medicine,, Medical College of Wisconsin, Milwaukee, WI USA
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Hama T, Ushijima A, Goto T, Nagamatsu H, Morita N, Yoshimachi F, Ikari Y, Kobayashi Y. Effect of Cardiac Rehabilitation on Glomerular Filtration Rate Using Serum Cystatin C Concentration in Patients With Cardiovascular Disease and Renal Dysfunction. J Cardiopulm Rehabil Prev 2022; 42:E15-E22. [PMID: 34793359 PMCID: PMC8884179 DOI: 10.1097/hcr.0000000000000651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Among patients with chronic kidney disease (CKD), little is known about whether the effect of cardiac rehabilitation (CR) on renal function differs across baseline estimated glomerular filtration rate using the serum concentration of cystatin C (eGFRcys). The aim of this study was to evaluate the effect of CR on renal function in patients with CKD. METHODS We performed a retrospective cohort study of patients with CKD (15 ≤ eGFRcys < 60 mL/min/1.73 m2) who participated in our CR program for cardiovascular disease. First, the patients were divided into three groups according to the baseline severity of the eGFRcys: G3a, G3b, and G4 groups. We compared the eGFRcys before and after the CR in each group. Second, to determine the association of baseline eGFRcys with the effect of CR, we fitted a linear regression model using the percent change in the eGFRcys (%ΔeGFRcys) as an outcome. RESULTS Of the 203 patients, 122 were in G3a, 60 were in G3b, and 21 were in G4 groups. The mean improvement of eGFRcys in each group was 1.3, 3.1, and 4.8 mL/min/1.73 m2, respectively. The %ΔeGFRcys was larger among patients with lower baseline eGFRcys (0.47% greater improvement of %ΔeGFRcys/one lower baseline eGFRcys; 95% CI, 0.23-0.72%). This association remained significant after adjustment for potential confounders (0.63% greater improvement of %ΔeGFRcys/one lower baseline eGFRcys; 95% CI, 0.35-0.91%). CONCLUSIONS The effect of CR on renal function was greater in patients with worse renal dysfunction measured by eGFRcys. A CR program could be useful for patients with severe renal dysfunction and it might have a beneficial effect on their renal function.
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Affiliation(s)
- Tomoaki Hama
- The Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan (Drs Hama, Ushijima, Nagamatsu, Morita, Yoshimachi, and Kobayashi); TXP Medical Co Ltd, Tokyo, and Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan (Dr Goto); and The Division of Cardiology, Department of Medicine, Tokai University Hospital, Shibuya City, Tokyo, Japan (Dr Ikari)
| | - Akiko Ushijima
- The Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan (Drs Hama, Ushijima, Nagamatsu, Morita, Yoshimachi, and Kobayashi); TXP Medical Co Ltd, Tokyo, and Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan (Dr Goto); and The Division of Cardiology, Department of Medicine, Tokai University Hospital, Shibuya City, Tokyo, Japan (Dr Ikari)
| | - Tadahiro Goto
- The Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan (Drs Hama, Ushijima, Nagamatsu, Morita, Yoshimachi, and Kobayashi); TXP Medical Co Ltd, Tokyo, and Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan (Dr Goto); and The Division of Cardiology, Department of Medicine, Tokai University Hospital, Shibuya City, Tokyo, Japan (Dr Ikari)
| | - Hirofumi Nagamatsu
- The Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan (Drs Hama, Ushijima, Nagamatsu, Morita, Yoshimachi, and Kobayashi); TXP Medical Co Ltd, Tokyo, and Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan (Dr Goto); and The Division of Cardiology, Department of Medicine, Tokai University Hospital, Shibuya City, Tokyo, Japan (Dr Ikari)
| | - Norishige Morita
- The Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan (Drs Hama, Ushijima, Nagamatsu, Morita, Yoshimachi, and Kobayashi); TXP Medical Co Ltd, Tokyo, and Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan (Dr Goto); and The Division of Cardiology, Department of Medicine, Tokai University Hospital, Shibuya City, Tokyo, Japan (Dr Ikari)
| | - Fuminobu Yoshimachi
- The Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan (Drs Hama, Ushijima, Nagamatsu, Morita, Yoshimachi, and Kobayashi); TXP Medical Co Ltd, Tokyo, and Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan (Dr Goto); and The Division of Cardiology, Department of Medicine, Tokai University Hospital, Shibuya City, Tokyo, Japan (Dr Ikari)
| | - Yuji Ikari
- The Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan (Drs Hama, Ushijima, Nagamatsu, Morita, Yoshimachi, and Kobayashi); TXP Medical Co Ltd, Tokyo, and Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan (Dr Goto); and The Division of Cardiology, Department of Medicine, Tokai University Hospital, Shibuya City, Tokyo, Japan (Dr Ikari)
| | - Yoshinori Kobayashi
- The Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan (Drs Hama, Ushijima, Nagamatsu, Morita, Yoshimachi, and Kobayashi); TXP Medical Co Ltd, Tokyo, and Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan (Dr Goto); and The Division of Cardiology, Department of Medicine, Tokai University Hospital, Shibuya City, Tokyo, Japan (Dr Ikari)
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Oh TR, Choi HS, Suh SH, Kim CS, Bae EH, Sung S, Han SH, Oh KH, Ma SK, Kim SW. The Association between Health-Enhancing Physical Activity and Quality of Life in Patients with Chronic Kidney Disease: Propensity Score Matching Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031318. [PMID: 35162341 PMCID: PMC8835055 DOI: 10.3390/ijerph19031318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/19/2022] [Accepted: 01/23/2022] [Indexed: 12/02/2022]
Abstract
We investigate the association between health-enhancing physical activity and the quality of life in patients with non-dialysis chronic kidney disease. We performed data analysis on 1618 of 2238 patients from 2011 to 2016, obtained from the KoreaN Cohort Study for Outcome in Patients with Chronic Kidney Disease (KNOW-CKD). Health-related quality of life was measured using the Korean version 1.3 of Kidney Disease Quality of Life short-form questionnaire. Health-enhancing physical activity was defined as 150 min of moderate-intensity or 75 min of vigorous-intensity aerobic physical activity throughout the week. Propensity score matching analysis and linear regression was performed to estimate the effect of health-enhancing physical activity on health-related quality of life. The estimate of average treatment effects was 2.60 in the kidney component summary score, 4.45 in the physical component summary score, and 4.24 in the mental component summary score. In all component summary scores and most of their subscales, health-enhancing physical activity showed a significant association with health-related quality of life. Subgroup and sensitivity analyses also showed robust results. This study suggests that health-enhancing physical activity elevated quality of life in patients with non-dialysis chronic kidney disease. The results can contribute to encourage physical activity in patients with chronic kidney disease.
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Affiliation(s)
- Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebongro, Gwangju 61469, Korea; (T.R.O.); (H.S.C.); (S.H.S.); (C.S.K.); (E.H.B.)
- Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 61469, Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebongro, Gwangju 61469, Korea; (T.R.O.); (H.S.C.); (S.H.S.); (C.S.K.); (E.H.B.)
- Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 61469, Korea
| | - Sang Heon Suh
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebongro, Gwangju 61469, Korea; (T.R.O.); (H.S.C.); (S.H.S.); (C.S.K.); (E.H.B.)
- Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 61469, Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebongro, Gwangju 61469, Korea; (T.R.O.); (H.S.C.); (S.H.S.); (C.S.K.); (E.H.B.)
- Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 61469, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebongro, Gwangju 61469, Korea; (T.R.O.); (H.S.C.); (S.H.S.); (C.S.K.); (E.H.B.)
- Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 61469, Korea
| | - Suah Sung
- Department of Internal Medicine, Eulji Medical Center, Eulji University, Seoul 01830, Korea;
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul 03722, Korea;
| | - Kook Hwan Oh
- Department of Internal Medicine, Seoul National University, Seoul 03080, Korea;
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebongro, Gwangju 61469, Korea; (T.R.O.); (H.S.C.); (S.H.S.); (C.S.K.); (E.H.B.)
- Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 61469, Korea
- Correspondence: (S.K.M.); (S.W.K.); Tel.: +82-62-220-6579 (S.K.M.); +82-62-220-6271 (S.W.K.); Fax: +82-62-225-8578 (S.K.M. & S.W.K.)
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebongro, Gwangju 61469, Korea; (T.R.O.); (H.S.C.); (S.H.S.); (C.S.K.); (E.H.B.)
- Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 61469, Korea
- Correspondence: (S.K.M.); (S.W.K.); Tel.: +82-62-220-6579 (S.K.M.); +82-62-220-6271 (S.W.K.); Fax: +82-62-225-8578 (S.K.M. & S.W.K.)
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9
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Sato T, Kohzuki M, Ono M, Muto M, Osugi T, Kawamura K, Naganuma W, Sato M, Tsuchikawa M, Shishito N, Komaki T, Miyazawa K. Association between physical activity and changes in renal function in patients after acute myocardial infarction: A dual-center prospective study. J Cardiol 2021; 78:120-128. [PMID: 33766438 DOI: 10.1016/j.jjcc.2021.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Acute myocardial infarction (AMI) causes a decline in renal function. This study aimed to elucidate the longitudinal association between physical activity levels and changes in renal function up to 6 months after the onset of AMI. METHODS In this dual-center prospective observational study, 73 AMI patients (67 men; average age, 65.0±11.7 years) were enrolled from 2017 to 2019. Blood biochemistry, urinalysis, and physical function tests were conducted at discharge and 3 and 6 months post-discharge. The renal function was evaluated based on cystatin C-based estimated glomerular filtration rate (eGFRcys). The number of steps was recorded for 6 months post-discharge. Generalized estimating equation (GEE) models were used to test the longitudinal association between physical activity levels and within-patient changes in eGFRcys. Both GEE models with a follow-up period of 3 and 6 months were constructed to assess the effects of the passage of time. RESULTS Patients were stratified into the low (n=36; 2903±1187 steps/day) and high groups (n=37; 7988±3192 steps/day) based on the median number of steps. Both GEE models at the 3- (p=0.027) and 6-month follow-up (p=0.034) showed a significant positive association between the physical activity levels and within-patient changes in eGFRcys. The changes in eGFRcys at 6 months were -0.3 mL/min/1.73 m2 and +4.4 mL/min/1.73 m2 among the low and high group participants, respectively. CONCLUSIONS There was a significant positive association between physical activity and renal function changes after the onset of AMI, which persisted when the follow-up period was extended from 3 to 6 months. Our findings support the importance of interventions that enable maintaining high physical activity levels as a strategy for preserving renal function in AMI patients.
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Affiliation(s)
- Toshimi Sato
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, 1-1, Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan; Department of Rehabilitation, Southern Tohoku General Hospital, Koriyama, Japan
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, 1-1, Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan.
| | - Masahiro Ono
- Department of Cardiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Mitsuru Muto
- Department of Cardiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Taku Osugi
- Department of Cardiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Keiichi Kawamura
- Department of Cardiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Wakako Naganuma
- Department of Cardiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Masayuki Sato
- Department of Cardiology, Ohara General Hospital, Fukushima, Japan
| | | | - Namiko Shishito
- Department of Cardiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Toshiya Komaki
- Department of Rehabilitation, Shin Yurigaoka General Hospital, Kawasaki, Japan
| | - Kana Miyazawa
- Department of Rehabilitation, Shin Yurigaoka General Hospital, Kawasaki, Japan
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10
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Saud A, Luiz RS, Leite APO, Muller CR, Visona I, Reinecke N, Silva WH, Gloria MA, Razvickas CV, Casarini DE, Schor N. Resistance exercise training ameliorates chronic kidney disease outcomes in a 5/6 nephrectomy model. Life Sci 2021; 275:119362. [PMID: 33741414 DOI: 10.1016/j.lfs.2021.119362] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 11/15/2022]
Abstract
Chronic kidney disease (CKD) is defined by decreased glomerular filtration rate (GFR) or increased albumin excretion leading to renal injury. However, exercise training is an important non-pharmacological intervention that ameliorates and protects against Diabetes Mellitus, cardiovascular disease, and CKD. AIM Our aim was to evaluate the capability of resistance exercise training (RET) to improve CKD outcomes and the contribution of the renal and muscular Akt/mTOR signaling pathway for RET beneficial effects on a CKD model. MAIN METHODS Male Wistar rats were subjected to RET, followed for 10 weeks, and randomly divided into 5 groups: Sham: Sham-operated; sedentary and nephrectomy (5/6Nx) (SNS); exercising post-5/6Nx (SNE); exercising pre-5/6Nx (ENS); exercising pre- and post-5/6Nx (ENE). The systolic blood pressure (BP) was measured. Creatinine, proteinuria, and blood urea nitrogen (BUN) were evaluated. After euthanasia Renal and muscular Akt/mTOR signaling pathways were analyzed. KEY FINDING Our study showed that the SNS presented renal injury, hypertension, weight and muscular mass loss and a higher mortality rate. SNS group also decreased renal IL-10 and increased TNF-alfa and TGF-Beta. Renal AKT, mTOR, and rpS6 pathway were increased, PTEN was decreased on SNS. And muscular Akt and mTOR were decreased on SNS. SIGNIFICANCE The RET before and after the 5/6Nx ameliorates all these parameters mentioned above, suggesting that RET is a good non-pharmacological approach to diminish complications frequently found in CKD. We also suggest that the AKT-m-TOR pathway can play an important role in these beneficial outcomes of RET on the CKD animal model.
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Affiliation(s)
- A Saud
- Departamento de Medicina, Disciplina de Nefrologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brazil
| | - R S Luiz
- Departamento de Medicina, Disciplina de Nefrologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brazil
| | - A P O Leite
- Departamento de Medicina, Disciplina de Nefrologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brazil; Tulane University, Department of Physiology & Medicine, New Orleans, LA, United States
| | - C R Muller
- Department of Bioengineering, University of California San Diego, La Jolla, CA, United States
| | - I Visona
- Departamento de Patologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brazil
| | - N Reinecke
- Departamento de Medicina, Disciplina de Nefrologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brazil
| | - W H Silva
- Departamento de Medicina, Disciplina de Nefrologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brazil
| | - M A Gloria
- Departamento de Medicina, Disciplina de Nefrologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brazil
| | - C V Razvickas
- Departamento de Medicina, Disciplina de Nefrologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brazil
| | - D E Casarini
- Departamento de Medicina, Disciplina de Nefrologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brazil.
| | - N Schor
- Departamento de Medicina, Disciplina de Nefrologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brazil
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11
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Sasamoto Y, Endo N, Kanazawa K, Utsumi T, Takahashi T, Endo Y, Nanba M, Takeda H, Takano T, Takahashi K, Tanji M, Kohzuki M. Outpatient Cardiac Rehabilitation Suppresses Deterioration of Renal Function in Patients ≥75 Years of Age With Heart Disease. Circ J 2021; 85:612-622. [PMID: 33536402 DOI: 10.1253/circj.cj-20-0970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study investigated the effect of outpatient cardiac rehabilitation (OCR) and physical activity on the estimated glomerular filtration rate based on serum cystatin C (eGFRcys) in patients with heart disease (HD) aged ≥75 years.Methods and Results:This non-randomized prospective intervention study involved 136 patients (non-OCR group, n=66; OCR group, n=70), 55 of whom were aged ≥75 years (non-OCR group, n=29; OCR group, n=26). Renal function (eGFRcys) was evaluated at discharge and 3 months thereafter. A linear mixed model (LMM) was used to assess changes in renal function over time. The hospital readmission rate within 3 months after discharge was also evaluated. LMM analysis showed that the change in eGFRcys was -2.27 and +0.48 mL/min/1.73 m2in the non-OCR and OCR groups, respectively (F=2.960, P=0.022). Further, among patients aged ≥75 years in the non-OCR and OCR groups, the change in eGFRcys was -3.83 and -1.08 mL/min/1.73 m2, respectively (F=2.719, P=0.039). The proportion of patients aged ≥75 years who were rehospitalized due to exacerbation of HD was 16.9% (n=10) and 6.7% (n=2) in the non-OCR and OCR groups, respectively. CONCLUSIONS Among patients with HD aged ≥75 years, participation in OCR reduces the decline in renal function and hospital readmission rates.
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Affiliation(s)
- Yuichiro Sasamoto
- Department of Internal Medicine & Rehabilitation Science Disability Science, Tohoku University Graduate School of Medicine.,Department of Rehabilitation, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital
| | - Noriko Endo
- Department of Public Health, Fukushima Medical University.,Department of Cardiology & Cardiac Rehabilitation, Choja-2-chome Kaoriyama Clinic
| | - Kohko Kanazawa
- Department of Cardiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital
| | - Taeko Utsumi
- Department of Rehabilitation, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital
| | - Tomomi Takahashi
- Department of Rehabilitation, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital
| | - Yosuke Endo
- Department of Rehabilitation, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital
| | - Makoto Nanba
- Department of Rehabilitation, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital
| | - Hiroto Takeda
- Department of Cardiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital
| | - Tomohiro Takano
- Department of Cardiovascular Surgery, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital
| | - Koki Takahashi
- Department of Cardiovascular Surgery, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital
| | - Masahiro Tanji
- Department of Cardiovascular Surgery, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital
| | - Masahiro Kohzuki
- Department of Internal Medicine & Rehabilitation Science Disability Science, Tohoku University Graduate School of Medicine
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12
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Luo L, Xu WQ, Zhong RX, Chen F, Fu YL, Zhang P, Xiao SH. Clinical efficacy and safety of percutaneous coronary intervention for acute myocardial infarction complicated with chronic renal insufficiency: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e16005. [PMID: 31192944 PMCID: PMC6587819 DOI: 10.1097/md.0000000000016005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of this research is to further evaluate the efficacy and safety of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) complicated with chronic renal insufficiency (CRI) by meta-analysis, to provide scientific and effective medical evidence for PCI in patients with AMI complicated with CRI, and to support the clinical application of PCI. METHODS Electronic databases will be searched, including PubMed, Cochrane Library, Embase, CNKI, CBM, VIP, and Wanfang Data. Patients with AMI complicated by renal insufficiency treated with PCI will be included. The retrieval time is from inception to January 2019. The inclusion and exclusion criteria are formulated to search only the relevant literature. Endnote software management for literature will be adopted. The literature will be independently screened by 2 researchers. Excel 2016 will be applied to extract literature data with the "Research Information Registration Form." The final selected literature will be assessed for bias risk. Stata 12.0 software will be used for the meta-analysis. RESULTS The systematic evaluation and meta-analysis will be carried out strictly in accordance with the requirements of the Cochrane System Evaluator Manual 5.3 on meta-analyses, which will provide a high-quality evaluation of the clinical efficacy and safety of PCI in patients with AMI and CRI. ETHICS AND DISSEMINATION This study belongs to the category of systematic reviews, not clinical trials. Therefore, it does not require ethical approval. The results of this study will be published in influential international academic journals related to this topic. CONCLUSION PCI is an effective and safe treatment for patients with AMI and CRI. This study will provide a definite evidence-based medical conclusion and provide a scientific basis for the clinical treatment of patients with AMI and CRI. PROSPERO REGISTRATION NUMBER CRD42019131367.
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Affiliation(s)
- Liang Luo
- NO.2 Department of Internal Medicine-Cardiovascular, Ganzhou People's Hospital
| | - Wen-Qing Xu
- NO.2 Department of Internal Medicine-Cardiovascular, Ganzhou People's Hospital
| | - Ri-Xiang Zhong
- NO.1 Department of Internal Medicine, First People's Hospital of Longnan County
| | - Feng Chen
- NO.2 Department of Internal Medicine-Cardiovascular, Ganzhou People's Hospital
| | - You-Lin Fu
- NO.2 Department of Internal Medicine-Cardiovascular, Ganzhou People's Hospital
| | - Peng Zhang
- NO.2 Department of Internal Medicine-Cardiovascular, Ganzhou People's Hospital
| | - Shi-Hui Xiao
- NO.1 Department of Internal Medicine-Cardiovascular, Ganzhou People's Hospital, Ganzhou, Jiangxi Province, 341000, China
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