Exercise in patients with hypertension and chronic kidney disease: a randomized controlled trial

Abstract

Hypertension and chronic kidney disease (CKD) are global public health problems, both associated with higher risk of cardiovascular (CV) and renal events. This trial randomized non-diabetic adult patients with hypertension and CKD stages 2-4 to 16 weeks of aerobic and resistance training or usual care. The primary outcome was the change in estimated glomerular filtration rate (eGFR). Secondary outcomes included changes in systolic and diastolic blood pressure (BP), body weight, fasting blood glucose, lipid profile, high-sensitivity C-reactive protein (hs-CRP), and functional capacity. The analysis was performed by intention-to-treat, using linear mixed-effects models for repeated measures over time. A hundred fifty patients were included in the intervention (76) or control (74) groups. No difference was found in eGFR, BP, body weight, or lipid profile changes between the groups. However, there were significant decreases in hs-CRP [-6.7(-11.7 to -1.8) mg/L] and fasting blood glucose [-11.3(-20.0 to -1.8) mg/dL], and an increase in functional capacity [2' Step Test 33.9 (17.7-50.0); 30″ Stand Test 2.3 (0.9-3.7)] in exercise group compared with control group. The results of this RCT show that combined aerobic and resistance training could reduce inflammation and insulin resistance in hypertensive patients with earlier stages of CKD, without a significant effect on kidney disease progression. Clinical trials.gov NCT01155128.

The effect of exercise on blood pressure in chronic kidney disease: A systematic review and meta-analysis of randomized controlled trials

“…Exercise is an appealing strategy for BP control in people with CKD because exercise has shown other benefits in this population[21–23] and also because the attainment of BP targets is potentially cost saving. [24] Therefore, we conducted this systematic review to evaluate the evidence for exercise as a strategy to lower blood pressure in people with non-dialysis dependent CKD (stages 3–5 estimated glomerular filtration rate <60 mL/min/1.73m 2 ).…”

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

“…Kirkman 17 42 showed different time points of measurements in the outcome data because all patients were followed for a minimum of 1.5 years or until the necessity for dialysis or kidney transplantation, which were possibilities of measurement bias. Seven trials 16,18,19,21,30,32,36 (within all reported outcomes) had enlisted in clinical trial registries or study protocols, whereas 5 trials 8,17,20,28,41 (Fig. 2).…”

“…2). Overall, 4 trials 20,29,32,42 reported the death of participants; however, those were not related to exercise training. Subgroup analysis performed for exercise types, estimated glomerular filtration rate (eGFR) (< 30 or ≥ 30 mL/min/1.73 m 2 ), and body mass index (BMI) (< 30 or ≥ 30 kg/m 2 ) showed no evidence of differences between the groups (test for subgroup difference: P = 0.74, 0.49, and 0.68, respectively).…”

“…Nine trials including 459 participants reported eGFR as outcomes. eGFRs were mostly evaluated using the CKD-Epidemiology Collaboration (EPI) creatinine equation 18,20,28 or the Modification of Diet in Renal Disease (MDRD) formula 8,16,17,19,30,36 . The results showed that the effect of exercise training on eGFR was not significant compared to usual care (mean difference (MD), − 0.34; 95% CI − 1.91 to 1.22; participants = 459, trials = 9; I 2 = 0%) ( Fig.…”

Role of exercise in blood pressure control among hypertensive chronic kidney disease patients

“…Combined aerobic and resistance training was noted as a potential therapy in decreasing inflammation, thereby improving endothelial function in hypertensive early-stage CKD patients. [ 2 ]…”