title: Effect of exercise training on estimated GFR, vascular health, and cardiorespiratory fitness in patients with CKD: a pilot randomized controlled trial.
abstract: 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.
  
  
  METHODS
  Single-blind, randomized, controlled, parallel trial.
  
  
  METHODS
  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)≥2.9mL/min/1.73m(2) per year for 12 months preintervention. Patients were excluded if they had unstable medical conditions or had recently started regular exercise.
  
  
  METHODS
  The rehabilitation group received resistance and aerobic training (3 days per week) for a 12-month period. The usual care group received standard care.
  
  
  RESULTS
  Kidney function assessed by comparing mean rate of change in eGFRcr (mL/min/1.73m(2) 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.
  
  
  METHODS
  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/1.73m(2) 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Renal Medicine, King's College Hospital, London, United Kingdom; Renal Medicine, King's College Hospital, London, United Kingdom. Electronic address: sharlene.greenwood@nhs.net.
authors.forename: Sharlene A
authors.initials: SA
authors.lastname: Greenwood
authors.affiliation: School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom.
authors.forename: Pelagia
authors.initials: P
authors.lastname: Koufaki
authors.affiliation: School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mercer
authors.affiliation: Department of Renal Medicine, King's College Hospital, London, United Kingdom.
authors.forename: Helen L
authors.initials: HL
authors.lastname: MacLaughlin
authors.affiliation: School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Rush
authors.affiliation: Department of Renal Medicine, King's College Hospital, London, United Kingdom.
authors.forename: Herolin
authors.initials: H
authors.lastname: Lindup
authors.affiliation: Department of Renal Medicine, King's College Hospital, London, United Kingdom.
authors.forename: Ellen
authors.initials: E
authors.lastname: O'Connor
authors.affiliation: Department of Renal Medicine, King's College Hospital, London, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Jones
authors.affiliation: Renal Medicine, King's College Hospital, London, United Kingdom.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Hendry
authors.affiliation: Department of Renal Medicine, King's College Hospital, London, United Kingdom.
authors.forename: Iain C
authors.initials: IC
authors.lastname: Macdougall
authors.affiliation: Department of Renal Medicine, King's College Hospital, London, United Kingdom.
authors.forename: Hugh S
authors.initials: HS
authors.lastname: Cairns
mesh_terms: D000328:Adult; D000368:Aged; D004730:Endothelium, Vascular; D005080:Exercise Test / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005919:Glomerular Filtration Rate; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness; D010865:Pilot Projects; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016037:Single-Blind Method; D016896:Treatment Outcome
keywords: Rehabilitation; Vo(2peak); arterial stiffness; cardio-respiratory fitness; cardiovascular risk; chronic kidney disease (CKD); end-stage renal failure; estimated glomerular filtration rate (eGFR); exercise; kidney disease trajectory; physical activity; pulse wave velocity (PWV)