Effect of Exercise Training on Estimated GFR, Vascular Health, and Cardiorespiratory Fitness in Patients With CKD: A Pilot Randomized Controlled Trial
Abstract
Background Exercise capacity, which is predictive of all-cause mortality and cardiovascular disease risk, is reduced significantly in patients with non-dialysis-dependent chronic kidney disease. This pilot study examined the effect of moderate-intensity exercise training on kidney function and indexes of cardiovascular risk in patients with progressive chronic kidney disease stages 3 to 4. Study design Single-blind, randomized, controlled, parallel trial. Setting & participants 20 patients (aged 18-80 years; 17 men) randomly assigned to rehabilitation (n=10) or usual care (n=10). Participants were included if they were 18 years or older and had evidence of rate of decline in creatinine-based estimated glomerular filtration rate (eGFRcr)≥2.9mL/min/1.73m(2) per year for 12 months preintervention. Patients were excluded if they had unstable medical conditions or had recently started regular exercise. Intervention The rehabilitation group received resistance and aerobic training (3 days per week) for a 12-month period. The usual care group received standard care. Outcomes Kidney function assessed by comparing mean rate of change in eGFRcr (mL/min/1.73m(2) per year) from a 12-month preintervention period against the 12-month intervention period. Pulse wave velocity (PWV), peak oxygen uptake (Vo2peak), and waist circumference assessed at 0, 6, and 12 months. Measurements eGFR assessed using creatinine, cystatin C (eGFRcys), and a combination of both values (eGFRcr-cys). Results 18 participants (rehabilitation, 8; usual care, 10) completed the study. A significant mean difference in rate of change in eGFRcr (+7.8±3.0 [95% CI, 1.1-13.5] mL/min/1.73m(2) per year; P=0.02) was observed between the rehabilitation and usual care groups, with the rehabilitation group demonstrating a slower decline. No significant between-group mean differences existed in absolute eGFRcr, eGFRcr-cys, or eGFRcys at 12 months of study intervention. Significant between-group mean differences existed in PWV (-2.30 [95% CI, -3.02 to -1.59] m/s), waist circumference (-7.1±12.8 [95% CI, -12.4 to -3.2] cm), and Vo2peak (5.7 [95% CI, 1.34-10.10] mL/kg/min). Change in eGFRcr was correlated inversely with PWV (r=-0.5; P=0.04) at 12 months. Limitations Small sample size, inconsistency between primary and secondary measures of kidney function. Conclusions The effect of a 1-year exercise intervention on progression of kidney disease is inconclusive. A larger study with longer follow-up may be necessary.
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High risk of performance bias was granted to more than 75% of the included studies.
“high risk of performance bias was granted to more than 75% of the studies [7, 9, 10, 13, 15–18, 20, 21].”
From Exercise therapy improves eGFR, and reduces blood pressure and BMI in non-dialysis CKD patients: evidence from a meta-analysis (2019) · cites this paper as [10]
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- Authors
- Greenwood, S. A., Koufaki, P., Mercer, T. H., MacLaughlin, H. L., Rush, R., Lindup, H., O’Connor, E., Jones, C., Hendry, B. M., Macdougall, I. C., & Cairns, H. S.
- Affiliations
- King's College London (GB)
- Queen Margaret University (GB)
- King's College Hospital (GB)
- Corresponding author
- Greenwood, Sharlene A.
- ORCID
- Venue
- American Journal of Kidney Diseases
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 65
- Issue
- 3
- Pages
- 425-434
- ISSN
- 0272-6386 (ISSN-L)
- OpenAlex
- W1971139165
- Cited by
- 193
- References
- 46
- Citations by year
- 2026: 14 · 2025: 11 · 2024: 18 · 2023: 20 · 2022: 18 · 2021: 22 · 2020: 21 · 2019: 19 · 2018: 19 · 2017: 18 · 2016: 9 · 2015: 4
- FWCI
- 20.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Kidney Diseases (publishedVersion)
- PubMed (publishedVersion)
- Queen Margaret University Publications Repository (Queen Margaret University) (submittedVersion)
- Funders
- National Institute for Health Research (NIHR) Doctoral Research Fellowship
- NIHR
- King’s College Hospital National Health Service (NHS) Trust
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- exercise training, chronic kidney disease, estimated glomerular filtration rate, estimated glomerular filtration rate decline, resistance training, aerobic exercise, pulse wave velocity, vascular health, cardiorespiratory fitness, peak oxygen uptake, cystatin C, cardiovascular risk, predialysis, rehabilitation, waist circumference, creatinine-based eGFR, all-cause mortality
- MeSH terms
- Adult, Aged, Endothelium, Vascular, Exercise Test, Exercise Therapy, Female, Glomerular Filtration Rate, Health Status, Humans, Male, Middle Aged, Physical Fitness, Pilot Projects, Single-Blind Method, Treatment Outcome, Renal Insufficiency, Chronic
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