Effect of Exercise Training on Estimated GFR, Vascular Health, and Cardiorespiratory Fitness in Patients With CKD: A Pilot Randomized Controlled Trial

Background Exercise capacity, which is predictive of all-cause mortality and cardiovascular disease risk, is reduced significantly in patients with non–dialysis-dependent chronic kidney disease. This pilot study examined the effect of moderate-intensity exercise training on kidney function and indexes of cardiovascular risk in patients with progressive chronic kidney disease stages 3 to 4. Study Design Single-blind, randomized, controlled, parallel trial. Setting & Participants 20 patients (aged 18-80 years; 17 men) randomly assigned to rehabilitation (n = 10) or usual care (n = 10). Participants were included if they were 18 years or older and had evidence of rate of decline in creatinine-based estimated glomerular filtration rate (eGFRcr) ≥ 2.9 mL/min/1.73 m2 per year for 12 months preintervention. Patients were excluded if they had unstable medical conditions or had recently started regular exercise. Intervention The rehabilitation group received resistance and aerobic training (3 days per week) for a 12-month period. The usual care group received standard care. Outcomes Kidney function assessed by comparing mean rate of change in eGFRcr (mL/min/1.73 m2 per year) from a 12-month preintervention period against the 12-month intervention period. Pulse wave velocity (PWV), peak oxygen uptake (Vo2peak), and waist circumference assessed at 0, 6, and 12 months. Measurements eGFR assessed using creatinine, cystatin C (eGFRcys), and a combination of both values (eGFRcr-cys). Results 18 participants (rehabilitation, 8; usual care, 10) completed the study. A significant mean difference in rate of change in eGFRcr (+7.8 ± 3.0 [95% CI, 1.1-13.5] mL/min/1.73 m2 per year; P = 0.02) was observed between the rehabilitation and usual care groups, with the rehabilitation group demonstrating a slower decline. No significant between-group mean differences existed in absolute eGFRcr, eGFRcr-cys, or eGFRcys at 12 months of study intervention. Significant between-group mean differences existed in PWV (−2.30 [95% CI, −3.02 to −1.59] m/s), waist circumference (−7.1 ± 12.8 [95% CI, −12.4 to −3.2] cm), and Vo2peak (5.7 [95% CI, 1.34-10.10] mL/kg/min). Change in eGFRcr was correlated inversely with PWV (r = −0.5; P = 0.04) at 12 months. Limitations Small sample size, inconsistency between primary and secondary measures of kidney function. Conclusions The effect of a 1-year exercise intervention on progression of kidney disease is inconclusive. A larger study with longer follow-up may be necessary. Exercise capacity, which is predictive of all-cause mortality and cardiovascular disease risk, is reduced significantly in patients with non–dialysis-dependent chronic kidney disease. This pilot study examined the effect of moderate-intensity exercise training on kidney function and indexes of cardiovascular risk in patients with progressive chronic kidney disease stages 3 to 4. Single-blind, randomized, controlled, parallel trial. 20 patients (aged 18-80 years; 17 men) randomly assigned to rehabilitation (n = 10) or usual care (n = 10). Participants were included if they were 18 years or older and had evidence of rate of decline in creatinine-based estimated glomerular filtration rate (eGFRcr) ≥ 2.9 mL/min/1.73 m2 per year for 12 months preintervention. Patients were excluded if they had unstable medical conditions or had recently started regular exercise. The rehabilitation group received resistance and aerobic training (3 days per week) for a 12-month period. The usual care group received standard care. Kidney function assessed by comparing mean rate of change in eGFRcr (mL/min/1.73 m2 per year) from a 12-month preintervention period against the 12-month intervention period. Pulse wave velocity (PWV), peak oxygen uptake (Vo2peak), and waist circumference assessed at 0, 6, and 12 months. eGFR assessed using creatinine, cystatin C (eGFRcys), and a combination of both values (eGFRcr-cys). 18 participants (rehabilitation, 8; usual care, 10) completed the study. A significant mean difference in rate of change in eGFRcr (+7.8 ± 3.0 [95% CI, 1.1-13.5] mL/min/1.73 m2 per year; P = 0.02) was observed between the rehabilitation and usual care groups, with the rehabilitation group demonstrating a slower decline. No significant between-group mean differences existed in absolute eGFRcr, eGFRcr-cys, or eGFRcys at 12 months of study intervention. Significant between-group mean differences existed in PWV (−2.30 [95% CI, −3.02 to −1.59] m/s), waist circumference (−7.1 ± 12.8 [95% CI, −12.4 to −3.2] cm), and Vo2peak (5.7 [95% CI, 1.34-10.10] mL/kg/min). Change in eGFRcr was correlated inversely with PWV (r = −0.5; P = 0.04) at 12 months. Small sample size, inconsistency between primary and secondary measures of kidney function. The effect of a 1-year exercise intervention on progression of kidney disease is inconclusive. A larger study with longer follow-up may be necessary.