Disclosures: Uchiyama reports no relevant financial disclosures.
January 27, 2022
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Home-based exercise linked with reduced renal function decline in stage 4 CKD

Disclosures: Uchiyama reports no relevant financial disclosures.
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Patients with stage 4 chronic kidney disease benefit from a 24-week home-based exercise program, according to data published in Kidney Medicine.

Further, the exercise program may cause lasting improvements to patients’ renal function after completion.

Exercise equipment
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Aerobic and resistance training in patients with CKD, including those with predialysis CKD and with hemodialysis or peritoneal dialysis, is increasingly known to be beneficial,” Kiyotaka Uchiyama, MD, PhD, from the departments of endocrinology, metabolism and nephrology at Keoi University School of Medicine in Tokyo, and colleagues wrote. “We recently demonstrated that a home-based exercise program including aerobic exercise and resistance exercise improved aerobic capacity as assessed by the incremental shuttle walking test, as well as health-related quality of life, serum C-reactive protein (an inflammatory marker), and acylcarnitine-to-free carnitine ratio in patients with stage 4 CKD (eGFR of 15-30 mL/min/1.73 m²).”

In a post-hoc analysis of a previous randomized controlled trial, Uchiyama and colleagues identified the impact of 24 weeks of home-based exercise on the changes in eGFR slope before, during and after the exercise period. Researchers measured eGFR seven, four and four times during the pre-exercise, mid-exercise and post-exercise periods, respectively.

The analysis included 46 patients randomly assigned to either the control group (n=23)or the exercise group (n=23). Researchers performed linear mixed models to determine patient’s eGFR slope.

The clinical characteristics of the groups stayed consistent between the exercise periods. Models revealed changes in estimated marginal mean in the exercise group (2.19 ± 0.79 mL/min/1.73 m²/year during the pre-exercise period to 1.60 ± 0.79 mL/min/1.73 m²/year mid-exercise and 2.19 ± 0.79 mL/min/1.73 m²/year during post-exercise) vs. the control group (1.55 ± 0.79 mL/min/1.73 m², 4.36 ± 0.79 mL/min/1.73 m² and 3.94 ± 0.79 mL/min/1.73 m²/year).

“In conclusion, participants randomly assigned to the exercise group exhibited significant improvement in eGFR from the pre-exercise period to the mid-exercise period, although the improvement in eGFR slope was attenuated from the pre-exercise period to the post-exercise period,” Uchiyama and colleagues wrote. “It is likely that acquired exercise habits from the 24-week intervention period in the exercise group led to the persistence of beneficial effects in that group during the post-exercise period. To evaluate the effect of habitual exercise separately from this ‘legacy’ effect, additional long-term trials with evaluation of physical activities after the end of intervention are necessary.”