Abstract
Background: Chronic kidney disease is directly related to cardiovascular disorders. Guided physical exercises significantly improve the adverse effects of dialytic treatment.
 Objective: To analyze changes in biochemical parameters of subjects with chronic kidney disease undergoing moderate exercise during hemodialysis.
 Methods: This is an experimental study composed of 54 subjects submitted to hemodialysis, split into a control group and a group with intervention. The experimental group underwent three weekly sessions of aerobic exercise, performed during hemodialysis sessions, with a duration of 30 minutes, for 12 weeks. The blood parameters of both groups were compared.
 Results: Statistically significant differences were observed between pre (p=0.001) and post-exercise protocol for urea (p=0.006), calcium (p=0.001), alanine aminotransferase (p=0.020) and sodium (p=<0.001). In the control group, we observed significant differences for the calcium variable (p<0.001), alanine aminotransferase (p=0.024), hematocrit (p=0.015), calcium vs phosphorus (p=0.018), and sodium (p=0.023), before and after the period.
 Conclusion: Aerobic training during hemodialysis was able to maintain blood level stability in patients with chronic kidney disease, both during and at the end of the protocol, even considering increased blood flow. This trial is registered in the Brazilian registry of clinical Trials - number RBR-7354r6. Registration date: July 5, 2018 at 12:59 PM. Last Update: July 24, 2018 at 10:24 AM. Identification of the test - UTN Number: U1111-1216-8272.
Highlights
The increase in chronic and degenerative diseases, such as chronic kidney disease (CKD), constitutes one of the most significant challenges of public health, as it is considered a worldwide social and economic problem, and associated to many co-morbidities, as well as to high expenses in public health[1,2].Subjects with CKD present less aerobic strength and functional capacity when compared to healthy inactive people[3]
The number of chronic kidney failure treated with hemodialysis is continuously increasing, and most patients have reduced exercise and are at high risk for heart and vascular disease[22]
The findings of our study showed that a moderate-load aerobic exercise protocol in patients undergoing hemodialysis for 3 months on a cycle ergometer did not change the blood parameters of patients with CKD
Summary
Subjects with CKD present less aerobic strength and functional capacity when compared to healthy inactive people[3]. Low cardiopulmonary and functional capacity are associated with higher mortality risk, hospital admissions, and co-morbidities in subjects in this population[4,5]. Several types of exercises proved to improve tolerance to exercise and optimize physical activity in subjects undergoing hemodialysis (HD)[6,7]. The muscular system’s energy demand increases oxygen consumption to a level 10 to 20 times higher than in rest[10]. This induces increased ROS flow in muscle fibers[11]. A response to the increase in ROS during physical training, especially when not exhaustive, is the induction of enzymatic Endogenous Antioxidant System (EAS) activation, which regulates enzymes such as Glutathione Peroxidase (GPx), Glutathione Reductase (GR) and Catalase (Cat) and Superoxide Reductase (SOD)[12,13]
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