Effects of exercise on kidney and physical function in patients with non-dialysis chronic kidney disease: a systematic review and meta-analysis

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.

Effect of Exercise on Health-Related Quality of Life in Patients with End-Stage Renal Disease

“…Pre-dialysis patients with severe CKD suffer from decreased physical function and performance due to a variety of factors, including renal function decline, arteriosclerosis, and chronic inflammation [26]. Pre-dialysis CKD patients with improved physical performance and higher PA levels have lower overall mortality and CVD risk [27].…”

Assessment of Exercise Intolerance in Patients with Pre-Dialysis CKD with Cardiopulmonary Function Testing: Translation to Everyday Practice

“…Small study samples, or inadequate duration of training programs may apply to some cases [63], although these were also features of some positive pilot studies [50, 62]. Characteristics of the included populations may also affect each study results, as meta-regression analyses suggest that older age, obesity, and diabetes may be factors leading to poor exercise response [67, 68].…”

“…Moreover, CPET use, through discrimination of the underlying causes of physical impairment and exertional fatigue in CKD patients, who suffer from multiple comorbidities, may facilitate treatment optimization towards symptom relief and functional capacity improvement. Furthermore, as exercise training has shown to improve physical function and walking capacity among subjects with CKD [68], CPET could be used to identify individuals with impaired exercise tolerance that would benefit from intervention. In addition, it can provide valuable information before the initiation of training, i.e., determine the optimal training intensity level and exercise safety, and after program completion, i.e., evaluate the efficacy of the intervention [28].…”

Home-based exercise for people living with frailty and chronic kidney disease: A mixed-methods pilot randomised controlled trial

“…Furthermore, the benefits may be sustained in the longer term, as they are implemented without the need for direct supervision, empowering patients to incorporate exercise within their daily lives. A recent systematic review and meta-analysis of exercise, including home-based exercise, in people with non-dialysis chronic kidney disease demonstrated improvements in physical and walking capacity [21]. However, the authors acknowledged that the generalisability of findings is "limited by age" as the "approximate mean age of participates in the included trials ranged from 50 to 65 years" [21].…”

“…A recent systematic review and meta-analysis of exercise, including home-based exercise, in people with non-dialysis chronic kidney disease demonstrated improvements in physical and walking capacity [21]. However, the authors acknowledged that the generalisability of findings is "limited by age" as the "approximate mean age of participates in the included trials ranged from 50 to 65 years" [21]. Studies in older frail non-CKD populations suggest that home-based exercise interventions are feasible and may be associated with improved outcomes, in terms of frailty, functional performance, nutritional status and falls incidence [22].…”