The effects of aerobic exercise on eGFR, blood pressure and VO2peak in patients with chronic kidney disease stages 3-4: A systematic review and meta-analysis.

Annemieke Dhondt,Anouk Tanghe,Bert Celie,Patrick Calders,Ans Van Ginckel,Karsten Vanden Wyngaert,Amaryllis H. Van Craenenbroeck,Wim Van Biesen

doi:10.1371/journal.pone.0203662

Abstract

BackgroundCKD is associated with several comorbidities, cardiovascular disease being the most significant. Aerobic training has a beneficial effect on cardiovascular health in healthy and some well-defined non-healthy populations. However, the effect of aerobic training on glomerular filtration rate in patients with CKD stages 3–4 is unclear.ObjectiveTo review the effects of aerobic exercise training on kidney and cardiovascular function in patients with chronic kidney disease (CKD) stages 3–4.MethodsA random-effects meta-analysis was performed to analyse published randomized controlled trials through February 2018 on the effect of aerobic training on estimated glomerular filtration rate, blood pressure and exercise tolerance in patients with CKD stages 3–4. Web of Science, PubMed and Embase databases were searched for eligible studies.Results11 randomized controlled trials were selected including 362 participants in total. Favourable effects were observed on estimated glomerular filtration rate (+2.16 ml/min per 1.73m2; [0.18; 4.13]) and exercise tolerance (+2.39 ml/kg/min; [0.99; 3.79]) following an on average 35-week aerobic training program when compared to standard care. No difference in change in blood pressure was found.ConclusionsThere is a small beneficial effect of aerobic training on estimated glomerular filtration rate and exercise tolerance, but not on blood pressure, in patients with CKD stages 3–4. However, data are limited and pooled findings were rated as of low to moderate quality.

Highlights

Patients with chronic kidney disease (CKD) have a high risk to develop cardiovascular (CV) disease, for which exercise training is known to be a successful preventive strategy [1]
A random-effects meta-analysis was performed to analyse published randomized controlled trials through February 2018 on the effect of aerobic training on estimated glomerular filtration rate, blood pressure and exercise tolerance in patients with CKD stages 3–4
Favourable effects were observed on estimated glomerular filtration rate (+2.16 ml/min per 1.73m2; [0.18; 4.13]) and exercise tolerance (+2.39 ml/kg/min; [0.99; 3.79]) following an on average 35-week aerobic training program when compared to standard care

Summary

Introduction

Patients with chronic kidney disease (CKD) have a high risk to develop cardiovascular (CV) disease, for which exercise training is known to be a successful preventive strategy [1]. The majority of patients with CKD do not meet the European Guidelines for physical activity of 150 min/week of moderate intensity (class I, level of recommendation A) [9]. This creates a vicious circle of worsened exercise intolerance and physical inactivity further enhancing increased CV risks [10]. Exercise tolerance plays a pivotal role in reaching recommended physical activity levels, which in turn is essential in the preservation of functional movement, general well-being and the management of CV risk factors (e.g. body weight control) in patients without CKD. The effect of aerobic training on glomerular filtration rate in patients with CKD stages 3–4 is unclear

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