Impacto sobre a capacidade aeróbica e marcadores cardiovasculares de um programa de exercício intradialítico com intensidade definida a partir do teste de caminhada de seis minutos em pacientes com doença renal crônica

Abstract

The relative risk of cardiovascular death in patients with stage 5 chronic kidney disease (CKD) is 20 to 30 times higher when compared to the general population. Patients with CKD on hemodialysis (HD) tend to be sedentary, which in combination with other risk factors present in these patients increases cardiovascular complications and mortality. Objectives: Evaluate the effects of an intradialytic aerobic exercise program in patients with CKD performing HD on aerobic fitness and cardiovascular markers. Methods: Sixteen patients with CKD in HD were randomly stratified into two groups: exercise group (EG=9) and control group (CG=7). Collected demographic, clinical and biochemical data of the patients studied. Performed six-minute walk test (6MWT) to define target heart rate (HR) according to Oliveira et al. (2016) who proposed, in a population with heart failure, the formula: maximum heart rate (HR) at 6MWT plus 10% (MHR6MWT+10%) for submaximal aerobic training. Executed an individualized exercise program on a bicycle adapted during the dialysis sessions, three times / week for three months, lasting 45 min. Estimated the peak VO2 by the formula of Cahalin et al. (1996). Analyzed distance walked in 6MWT (DW6M), estimated VO2, CRP and BNP. Descriptive statistical analysis of the data was carried out. Results: After three months of exercise, the EG presented a significant increase in the DW6M, and their respective VO2 estimated: 462.3 ± 46.4 m (16.4 ± 2.8 ml.kg-1.min-1) for 497.3 ± 61.39 m (18.8 ± 2.9 ml.kg-1.min-1), respectively p=0.032 and p=0.014. There was no significant difference in CG with 427.1 ± 79.2 m (15.1 ± 1.7 ml.kg-1.min-1) for 400.2 ± 127.1 m (16.1 ± 3.2 ml.kg-1.min-1), respectively p=0.346 and p=0.399. Median BNP values in EG were reduced from 69.0 pg/mL to 33.7 pg/mL (p=0.021) and there was no significant change in the CRP values. There were no serious adverse events in EG. Conclusions: An intradialytic cycloergometric aerobic exercise program with intensity defined through the 6MWT was effective, safe and practical in chronic renal patients in HD. There were significant gains in aerobic capacity (estimated VO2 and DW6M) and a statistically significant reduction in BNP levels. There were no significant reductions in CRP levels in both groups