A Trial of Lifestyle Modification on Cardiopulmonary, Inflammatory, and Metabolic Effects among Obese with Chronic Kidney Disease.
BACKGROUND
The feasibility and benefits of lifestyle intervention in chronic kidney disease (CKD) patients who are obese has not been well studied. We examined the early effects of an exercise plus weight loss intervention on body composition, exercise capacity, metabolic parameters and kidney function in obese subjects with CKD.


METHODS
Nine subjects (median age 57 years, body mass index (BMI) 43.9) underwent a lifestyle intervention program that included supervised aerobic exercise (i.e. ∼85% maximum heart rate) and dietary counseling (500 kcal reduction in daily caloric intake). Body composition (iDXA), exercise capacity (maximal oxygen consumption), quality of life, insulin resistance (Matsuda index), inflammation (high sensitivity C-reactive protein), adipokines (leptin and total adiponectin) and kidney function (iothalamate glomerular filtration rate) were measured at baseline and after 12 weeks of the intervention. Changes in parameters were compared using the Wilcoxon signed-rank test.


RESULTS
After 12 weeks of intervention, there was a significant decrease in BMI and fat mass (median -4.9 kg (25th-75th percentile -5.9 to -3.0)). There was a significant increase in exercise capacity (3.7 ml/kg/min (3.0-4.7)), along with improvements in insulin sensitivity (0.55 (0.43-1.2)), total adiponectin (780.9 μg/ml (262.1-1,497.1)) and leptin (-5.1 ng/ml (-14.5 to -3.3)). There were improvements in biomarkers of kidney disease very quality of life measures, but kidney function remained unchanged.


CONCLUSIONS
Lifestyle modification is feasible in obese patients with CKD and produces weight loss that is related to improvements in exercise capacity, insulin resistance and adipokines. Whether lifestyle-induced weight loss and fitness can be sustained and whether it will mediate improvements in kidney function over time merits further investigation.
Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Tex., USA.
Sankar D
SD
Navaneethan
Ciaran E
CE
Fealy
Amanda C
AC
Scelsi
Susana
S
Arrigain
Steven K
SK
Malin
John P
JP
Kirwan
D015502:Absorptiometry, Photon; D052242:Adiponectin / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D001823:Body Composition; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D055316:Cystatin C / Q000378:metabolism; D004038:Diet, Reducing / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D005919:Glomerular Filtration Rate; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D020738:Leptin / Q000378:metabolism; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D001613:beta 2-Microglobulin / Q000378:metabolism
D052242:Adiponectin; D001786:Blood Glucose; D055316:Cystatin C; D020738:Leptin; D001613:beta 2-Microglobulin; D002097:C-Reactive Protein