Longitudinal Analysis of Cardiovascular Risk Factors in Active and Sedentary Kidney Transplant Recipients

Abstract

Background: Despite the benefits of physical activity on cardiovascular risk in kidney transplant recipients (KTRs), the long-term effects of exercise have been poorly investigated. This is a three-year observational study comparing graft function and cardiovascular risk factors in active KTRs (AKTRs) vs. sedentary KTRs (SKTRs). Methods: KTRs with stable renal function were assigned to active or sedentary group in relation to the level of daily physical activity based on World Health Organization (WHO) recommendations (<150 or >150 minutes/week, respectively). Complete blood count, renal function indices, lipid profile, blood pressure and anthropometric measures were collected yearly for an observation period of three years. The comparisons between the two groups were performed by repeated measures analyses of covariance (ANCOVAs), with age as a covariate. Results: Fifty-four subjects were included in the study. Thirty of them were identified as AKTRs (M/F 26/4, aged 45 ± 12 years) and 24 as SKTRs (M/F 18/6, aged 51 ± 14 years). Baseline characteristics were similar between the groups except body mass index (BMI) that was significantly higher in SKTRs (p = 0.043). Furthermore, over the three-year observation period, BMI decreased in AKTRs and increased in SKTRs (p = 0.006). Graft function was stable in AKTRs, while it showed a decline over time in SKTRs, as indicated by the rise in serum creatinine levels (p = 0.006) and lower eGFR (p = 0.050). Proteinuria, glucose and uric acid levels displayed a decrease in AKTRs and an increase in SKTRs during the three-year period (p = 0.015, p = 0.004 and p = 0.013, respectively). Finally, concerning lipid profiles, AKTRs had a significant reduction over time of triglycerides levels, which conversely showed a clinically relevant increase in SKTRs (p = 0.014). Conclusions: Our findings indicate that regular weekly exercise training may counteract the increased cardiovascular risks and also prevent graft function decline in KTRs.

Physical activity and renal function in the Italian kidney transplant population

“…Previous evidence has shown that exercise provides benefits on metabolic profile, overweight and hypertension, factors closely related with clinical, functional and quality of life aspects in transplanted patients [ 4 ]. Indeed, PA represents a promising intervention tool for long-term preservation of renal function [ 3 , 5 , 10 ], although the currently available studies are based on small size populations and short follow-up periods [ 11 , 15 ]. In KTRs, estimated glomerular filtration rate (eGFR) decline over time is an important surrogate marker of death and graft failure [ 12 ].…”

Assessing health literacy in transplant patients to better tailor the content of their therapeutic education: an observational study

“…There is accumulating data indicating that regular exercise training may counteract the increased cardiovascular risk in transplant recipients. Recently, Totti et al 9 compared graft function and cardiovascular risk factors in active kidney transplant recipients and sedentary kidney transplant recipients. They found over a 3-year observation period that active kidney transplant recipients presented a reduction in body mass index and triglycerides levels, as well as a preservation of graft function conversely to sedentary kidney transplant recipients 9.…”

“…Recently, Totti et al 9 compared graft function and cardiovascular risk factors in active kidney transplant recipients and sedentary kidney transplant recipients. They found over a 3-year observation period that active kidney transplant recipients presented a reduction in body mass index and triglycerides levels, as well as a preservation of graft function conversely to sedentary kidney transplant recipients 9. The decline in bone mineral density in transplant recipients (attributed to immunosuppression and steroids) were reduced by targeted resistance training for at least 6 months 10.…”

Kidney Transplant Recipients’ Weight Change and their Behaviors and Attitudes Related to Diet and Exercise

“…While 55% of surveyed patients reported exercising after transplant, only 43% reported exercising at least two days a week. Those reporting no physical activity were significantly more likely to gain weight, suggesting that exercise may be an important factor in helping transplant patients prevents weight gain [18]. Most (79%) patients reported receiving exercising counseling, with 67% of those report finding it helpful.…”