The effect of exercise training in people with pre-dialysis chronic kidney disease: a systematic review with meta-analysis.

Abstract

Chronic kidney disease (CKD) is a global health issue with high mortality and economic costs. Exercise has potential benefits for pre-dialysis CKD management. This review examines the impact of exercise on CKD patients not on dialysis, focusing on improvement in various health parameters. Findings aim to inform the role of exercise in pre-dialysis CKD care. A systematic search of MEDLINE, EMBASE, the Cochrane Library of Controlled Trials, CINAHL, and SPORTDiscus, up to August 31, 2023, used key terms relating to pre-dialysis CKD and exercise. We pooled randomized controlled trials (RCTs) comparing exercise with usual care and conducted meta-analyses based on a random effects inverse variance model with the effect measure of mean difference. Of 1162 identified studies, 37 RCTs met the inclusion criteria including 1248 participants. Significant improvements were identified for peak VO2, mean difference [MD] (2.66mL/kg/min; 95% confidence interval [CI] 1.48, 3.83; p < 0.00001); the 6-min walk (MD 58.83m; 95% CI 35.26, 82.41; p < 0.00001), timed up and go (standardised mean difference -0.35; 95% CI -0.54, -0.15; p = 0.0006), 2-min step (MD 57.48 steps; 95% CI 27.80, 87.16; p = 0.0001), and sit to stand tests (MD 4.55 repetitions; 95% CI 1.49, 7.60; p = 0.004); short form [SF]-36 general health (MD 4.26; 95% CI 0.04, 8.47; p = 0.05); SF-36 mental component summary (MD 1.84; 95% CI 0.18, 3.51; p = 0.03); estimated glomerular filtration rate (MD 2.19mL/min/1.73 m2; 95% CI 0.97, 3.50; p = 0.001); serum cystatin-C (MD -0.06mg/L; 95% CI -0.11, -0.02; p = 0.004); resting heart rate (MD -1.97 bpm; 95% CI -3.84, -0.11; p = 0.04); triglycerides (MD -12.97mg/dL; 95% CI -17.30, -8.63; p < 0.00001); glycosylated haemoglobin (MD -0.25%; 95% CI -0.50, -0.01; p = 0.04); waist circumference (MD -3.12cm; 95% CI -4.37, -1.86; p < 0.00001); and interleukin-6 (MD -2.24pg/mL; 95% CI -3.87. -0.61; p = 0.007). Analysis revealed improvements in aerobic capacity, functional ability, quality of life, estimated glomerular filtration rate, serum cystatin-C, resting heart rate, waist circumference, triglyceride, glycosylated haemoglobin, and interleukin-6 levels.