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Cited by 132Chronic Kidney Disease and DiabetesCardiovascular and exercise physiologyPhysical Activity and Health

Exercise therapy improves eGFR, and reduces blood pressure and BMI in non-dialysis CKD patients: evidence from a meta-analysis

Open access
Zhang, Lijun, Wang, Yangyang, Xiong, Lianlian, Luo, Yanfang, Huang, Zhijun, Yi, Bin·2019·BMC Nephrology
DOI 10.1186/s12882-019-1586-5PMC PMC6821004
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Abstract

Background: Patients with chronic kidney disease (CKD) have a high prevalence of cardiovascular diseases, which often lead to physical inactivity that correlates with CKD exacerbation. The benefits of regular exercise to cardiovascular health have been well established in healthy population and highly suggestive in patients with CKD. To further strengthen the evidence base for the management of CKD, this meta-analysis was performed to systematically evaluate the effects of exercise therapy on renal function, blood pressure, blood lipid and body mass index (BMI) in non-dialysis CKD patients. Methods: This meta-analysis was conducted following a previous protocol. Randomized controlled trials (RCTs) examining the effects of exercise therapy in non-dialysis CKD patients were searched in Pubmed, Embase, Cochrane Library, and three major Chinese biomedical databases (CNKI, WANGFANG and VIP) from their start date to October 30th, 2018. The Cochrane systematic review methods were applied for quality assessment and data extraction, and Revman version 5.3 was used for systematic review and meta-analysis. Results: 13 RCTs, representing 421 patients with non-dialysis CKD, were included in this meta-analysis. Compared to the controls, exercise therapy brought an increase in eGFR (MD = 2.62, 95% CI:0.42 to 4.82, P = 0.02, I 2 = 22%), and decreases in systolic blood pressure (SBP) (MD = -5.61, 95% CI:-8.99 to − 2.23, P = 0.001, I 2 = 44%), diastolic blood pressure (DBP) (MD = -2.87, 95% CI:-3.65 to − 2.08, P < 0.00001, I 2 = 16%) and BMI (MD = -1.32, 95% CI:-2.39 to − 0.25, P = 0.02, I 2 = 0%) in non-dialysis CKD patients. Exercise therapy of short-term (< 3 months) decreased triglyceride (TG) level ( P = 0.0006). However, exercise therapy did not significantly affect serum creatinine (SCr), total cholesterol (TC), high density lipoprotein (HDL) or low density lipoprotein (LDL) in non-dialysis CKD patients. Conclusion: Exercise therapy could benefit non-dialysis CKD patients by increasing eGFR while reducing SBP, DBP and BMI. Additionally, short-term intervention of exercise could decrease TG.

AI snapshot

Written from the paper’s full text.

TL;DR

This meta-analysis of 13 RCTs in non-dialysis CKD patients found that exercise therapy increased eGFR and reduced systolic blood pressure, diastolic blood pressure, and BMI. It did not significantly affect serum creatinine, total cholesterol, HDL, or LDL overall, though short-term exercise reduced triglycerides.

Key findings

  • In 13 RCTs representing 421 non-dialysis CKD patients (experimental/control 212/209), exercise therapy increased eGFR (MD = 2.62, 95% CI 0.42–4.82, P = 0.02, I² = 22%); short-term exercise (<3 months) increased eGFR by 5.22 ml/min/1.73m² (MD = 5.22, 95% CI 0.68–9.77, P = 0.02), but 3–6 months and 6–12 months did not.
  • Exercise reduced SBP by 5.61 mmHg (MD = -5.61, 95% CI -8.99 to -2.23, P = 0.001, I² = 44%), DBP by 2.87 mmHg (MD = -2.87, 95% CI -3.65 to -2.08, P < 0.00001, I² = 16%), and BMI (MD = -1.32, 95% CI -2.39 to -0.25, P = 0.02, I² = 0%); BMI reduction was significant with 6–12 months of exercise (MD = -2.27, 95% CI -3.84 to -0.70, P = 0.005) but not <6 months.
  • Exercise did not significantly affect SCr (MD = -0.04, 95% CI -0.32 to 0.25, P = 0.79), TC (MD = 1.19, 95% CI -1.60 to 3.99, P = 0.40), HDL (MD = 0.17, 95% CI -0.17 to 0.51, P = 0.32), or LDL (MD = 2.79, 95% CI -1.73 to 7.32, P = 0.23).
  • Short-term exercise (<3 months) decreased TG (MD = -94.79, 95% CI -148.81 to -40.76, P = 0.0006), while 3–12 months increased TG (MD = 45.87, 95% CI 17.82 to 73.92, P = 0.001).

Methods

  • Systematic review and meta-analysis of RCTs; searched PubMed, Embase, Cochrane Library, CNKI, WANGFANG, and VIP from database start to October 30, 2018, for English or Chinese studies, following PRISMA and Cochrane methods; RevMan 5.3 used for analysis.
  • Included adults >18 years with non-dialysis CKD stage 2–5 receiving aerobic and/or resistance exercise at least once weekly for more than one month, with outcomes including eGFR, blood pressure, or blood lipids; 13 RCTs with 421 participants were included.
  • Continuous outcomes pooled as mean difference with 95% CI; heterogeneity assessed by χ² test and I²; fixed- or random-effects models used according to heterogeneity; subgroup analyses by exercise duration; sensitivity analysis by leave-one-out; publication bias assessed via funnel plots.

Limitations

  • Stated by the authors: included RCT designs were not entirely uniform; randomization and methods were not clearly described; sample size was relatively small; exercise mode, intensity, and frequency were not completely consistent; studies could not be accurately classified by exercise therapy type, so such subgroup analysis was not performed.
  • Evident from the text: participant counts are inconsistent across analyses (abstract reports 421 patients, while eGFR analysis reports 529 participants, SBP 463, DBP 399, and BMI 466), and high heterogeneity was present for SCr (I² = 72%), TG (I² = 78%), LDL (I² = 67%), and TC (I² = 54%).
  • Evident from the text: performance bias was high in more than 75% of included RCTs because blinding participants and personnel is challenging in exercise trials, and publication bias was assessed only through funnel plot symmetry.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12882-019-1586-5

Cites

34 of 34 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

10 of 17 cited sources checked · 7 supported · 0 flagged · accuracy not yet measured

  • Study design and conductreasoning

    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].”
    Quote in the paperNot a substantial claim5 of 10 sources checked
    • cites [7] Aoike DT, Baria F, Kamimura MA, Ammirati A, de Mello MT, Cuppari L. Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease. Int Urol Nephrol. 2015;47(2):359–67. source
    • cites [9] Toyama K, Sugiyama S, Oka H, Sumida H, Ogawa H. Exercise therapy correlates with improving renal function through modifying lipid metabolism in patients with cardiovascular disease and chronic kidney disease. J Cardiol. 2010;56(2):142–6. source

      The Methods section (page not provided) describes this study as an open-labeled clinical trial, which supports a concern about performance bias in this study. The paper does not assess performance bias across the citing document’s included studies or establish that more than 75% were rated high risk. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [10] Greenwood SA, Koufaki P, Mercer TH, MacLaughlin HL, Rush R, Lindup H, et al. Effect of exercise training on estimated GFR, vascular health, and cardiorespiratory fitness in patients with CKD: a pilot randomized controlled trial. Am J Kidney Dis. 2015;65(3):425–34. source
    • cites [13] Miele EM, Headley SAE, Germain M, Joubert J, Herrick S, Milch C, et al. High-density lipoprotein particle pattern and overall lipid responses to a short-term moderate-intensity aerobic exercise training intervention in patients with chronic kidney disease. Clin Kidney J. 2017;10(4):524–31. source

      The Results describe one randomized exercise intervention, and the Materials and methods describe its procedures. Neither section assesses performance bias across the citing paper’s included studies or reports that more than 75% were rated high risk. Searches for performance bias, blinding, and the 75% figure found no such assessment in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [15] Kiuchi MG, Chen S. The effect of the physical activity on polymorphic premature ventricular complexes in chronic kidney disease. Kidney Res Clin Pract. 2017;36(2):167–74. source
    • cites [16] Leehey DJ, Collins E, Kramer HJ, Cooper C, Butler J, McBurney C, et al. Structured exercise in obese diabetic patients with chronic kidney disease: a randomized controlled trial. Am J Nephrol. 2016;44(1):54–62. source
    • cites [17] Van Craenenbroeck AH, Van Craenenbroeck EM, Van Ackeren K, Vrints CJ, Conraads VM, Verpooten GA, et al. Effect of moderate aerobic exercise training on endothelial function and arterial stiffness in CKD stages 3-4: a randomized controlled trial. Am J Kidney Dis. 2015;66(2):285–96. source
    • cites [18] Baria F, Kamimura MA, Aoike DT, Ammirati A, Rocha ML, de Mello MT, et al. Randomized controlled trial to evaluate the impact of aerobic exercise on visceral fat in overweight chronic kidney disease patients. Nephrol Dial Transplant. 2014;29(4):857–64. source
    • cites [20] Headley S, Germain M, Milch C, Pescatello L, Coughlin MA, Nindl BC, et al. Exercise training improves HR responses and V O2peak in predialysis kidney patients. Med Sci Sports Exerc. 2012;44(12):2392–9. source
    • cites [21] Leehey DJ, Moinuddin I, Bast JP, Qureshi S, Jelinek CS, Cooper C, et al. Aerobic exercise in obese diabetic patients with chronic kidney disease: a randomized and controlled pilot study. Cardiovasc Diabetol. 2009;8:62. source
  • Findingown data

    HDL level is not significantly changed in non-dialysis CKD patients receiving 6-12 months of exercise therapy (MD = 0.19, 95% CI -0.16 to 0.53, P = 0.29).

    “and MD = 0.19, 95% CI: − 0.16 to 0.53, P = 0.29 for those receiving 6–12 months of exercise therapy, respectively”
    Quote in the paperNot a substantial claim
  • Findingown data

    DBP is decreased by 3.23 mmHg in non-dialysis CKD patients receiving less than 6 months of exercise therapy (MD = -3.23, 95% CI -5.53 to -0.93, P = 0.006).

    “DBP was decreased by 3.23 mmHg in subjects receiving less than 6 months of exercise therapy (MD = -3.23, 95% CI: − 5.53 to − 0.93, P = 0.006)”
    Quote in the paperSubstantial claim
  • Findingown data

    DBP is decreased by 2.82 mmHg in non-dialysis CKD patients receiving 6-12 months of exercise therapy (MD = -2.82, 95% CI -3.65 to -1.98, P < 0.00001).

    “and by 2.82 mmHg (MD = -2.82, 95% CI: − 3.65 to − 1.98, P < 0.00001) in subjects receiving 6–12 months of exercise therapy”
    Quote in the paperSubstantial claim
  • Findingown data

    eGFR is not significantly changed with 6-12 months of exercise in non-dialysis CKD patients (MD = 2.69, 95% CI -0.62 to 6.00, P = 0.11).

    “or 6–12 months of exercise (MD = 2.69, 95% CI: − 0.62 to 6.00, P = 0.11).”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 11
  • May combine two claims. 2

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Risk for detection bias was unclear in 4 RCTs and high in the Kiuchi study only.

    “Risk for detection bias was unclear in 4 RCTs [7, 13, 20, 21], and was scored as high in Kiuchi study only [15].”
    Quote in the paperNot a substantial claim3 of 5 sources checked
    • cites [7] Aoike DT, Baria F, Kamimura MA, Ammirati A, de Mello MT, Cuppari L. Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease. Int Urol Nephrol. 2015;47(2):359–67. source
    • cites [13] Miele EM, Headley SAE, Germain M, Joubert J, Herrick S, Milch C, et al. High-density lipoprotein particle pattern and overall lipid responses to a short-term moderate-intensity aerobic exercise training intervention in patients with chronic kidney disease. Clin Kidney J. 2017;10(4):524–31. source
    • cites [20] Headley S, Germain M, Milch C, Pescatello L, Coughlin MA, Nindl BC, et al. Exercise training improves HR responses and V O2peak in predialysis kidney patients. Med Sci Sports Exerc. 2012;44(12):2392–9. source
    • cites [21] Leehey DJ, Moinuddin I, Bast JP, Qureshi S, Jelinek CS, Cooper C, et al. Aerobic exercise in obese diabetic patients with chronic kidney disease: a randomized and controlled pilot study. Cardiovasc Diabetol. 2009;8:62. source
    • cites [15] Kiuchi MG, Chen S. The effect of the physical activity on polymorphic premature ventricular complexes in chronic kidney disease. Kidney Res Clin Pract. 2017;36(2):167–74. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The meta-analysis was conducted following a previously published protocol.

    “This meta-analysis was conducted following a previous protocol.”
    • Also stated in: § Quality assessment · plain
      “Following our previously published protocol [12]”
    • Also stated in: § Statistical analysis · plain
      “Statistical analyses were carried out according to a previous published plan [12].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] Wang Y, Yang S, Zhou Q, Zhang H, Yi B. Effects of vitamin D supplementation on renal function, inflammation and glycemic control in patients with diabetic nephropathy: a systematic review and Meta-analysis. Kidney Blood Press Res. 2019;44(1):72–87. source

      The Literature search strategy and Quality assessment sections describe how the meta-analysis was conducted, but neither says it followed a previously published protocol. Searches for “previous protocol,” “published protocol,” and “PROSPERO” found no passage establishing that point in our copy. (LLM, conf=0.72)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The systematic search and meta-analysis was performed and reported according to PRISMA guidelines.

    “This systematic search and meta-analysis was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [11] and checklist (Additional file 1: Checklist).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [11] Moher D, Liberati A, Tetzlaff J. Altman DG; PRISMA group. Preferred reporting items for systematic reviews and Meta-analyses: the PRISMA statement. Open Med 2009;3(3):123-30 . source

  • Probably not a substantial claim: may not pass S4 (based).

    Study design and conductnone given

    The literature collection was comprehensive.

    “our literature collection was comprehensive”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Some experimental designs and methods, such as randomization, were not clearly described in the included trials.

    “Some experimental designs and methods, such as randomization, were not clearly described.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The literature search was conducted by two authors independently.

    “The literature search was conducted by two of the authors (L.Z. and Y.W.) independently.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Only randomized controlled trials (RCTs) were included.

    “Only randomized controlled trials (RCTs) were included.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The included literatures could not be accurately classified according to the types of exercise therapy and such subgroup analysis was not performed.

    “The literatures included in this meta-analysis could not be accurately classified according to the types of exercise therapy and such subgroup analysis was not performed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The Cochrane systematic review methods were applied for quality assessment and data extraction.

    “The Cochrane systematic review methods were applied for quality assessment and data extraction”
    • Also stated in: § Quality assessment · plain
      “According to the Cochrane Collaboration for Systematic Reviews of Interventions, the following guidelines were applied to assess all included RCTs”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Quality assessment of selected RCTs was performed independently by two researchers.

    “two researchers (L.Z. and Y.W.) performed quality assessment of the selected RCTs independently.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Quantitative data were extracted independently by two authors.

    “Quantitative data were extracted from the included articles independently by two authors (L.Z. and Y.W.)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Subgroup analysis was carried out based on the duration of exercise intervention to ensure the reliability of the research results.

    “subgroup analysis was carried out based on the duration of exercise intervention to ensure the reliability of the research results.”
    Quote in the paperNot a substantial claim
12 of 12

  • The paper relies on this without support.

    The included RCTs are representative of the broader non-dialysis CKD patient population, so the pooled effects can be generalized to all non-dialysis CKD patients.

    “Exercise therapy could benefit non-dialysis CKD patients by increasing eGFR while reducing SBP, DBP and BMI.”
    “exercise therapy may be a potential strategy to improve eGFR, reduce SBP, DBP and BMI in non-dialysis CKD patients.”

  • The paper relies on this without support.

    Improvements in eGFR, SBP, DBP, and BMI from exercise therapy translate into clinical benefit for non-dialysis CKD patients.

    “Exercise therapy could benefit non-dialysis CKD patients by increasing eGFR while reducing SBP, DBP and BMI.”
    “exercise therapy may be a potential strategy to improve eGFR, reduce SBP, DBP and BMI in non-dialysis CKD patients.”
2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Table note assigns the wrong eGFR formula to some studies

    Minor

    The table note describes eGFR as calculated using the MDRD formula, but the results explicitly identify four studies that used the CKD-EPI creatinine equation.

  • Discussion singles out short-term blood-pressure significance despite significant longer-term results

    Minor

    The discussion characterizes the antihypertensive effect as specifically significant with less than six months of exercise. The results also report a significant SBP decrease with 6-12 months of exercise.

  • Aoike study's renal-function result is described oppositely

    Minor

    The background says Aoike et al. found no renal-function improvement, while Table 1 says the same study improved renal function.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Xiong XY, Bai SJ, Wang YK, Ji TT, Du HX, Li XY, et al. The effect of physical exercise on the physiological function of adult renal transplant recipients:a meta analysis. Zhonghua Shen Zang Bing Za Zhi. 2018;34(6):424–31.

Cited by

Sorted by citations

Related

Authors
Zhang, L., Wang, Y., Xiong, L., Luo, Y., Huang, Z., & Yi, B.
Affiliations
Central South University (CN)
Corresponding author
Yi, Bin
ORCID
Venue
BMC Nephrology
Publisher
Springer Science and Business Media LLC
Published
2019-10-29
Volume
20
Issue
1
Pages
398-398
ISSN
1471-2369 (ISSN-L)
DOI
10.1186/s12882-019-1586-5
PMC
PMC6821004
OpenAlex
W2982354070
Cited by
132
References
34
Citations by year
2026: 15 · 2025: 18 · 2024: 27 · 2023: 18 · 2022: 21 · 2021: 24 · 2020: 8 · 2018: 1
FWCI
2.66
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Nephrology (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion, cc-by)
  • PubMed Central (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • the New Xiangya Talent of Third Xiangya Hospital of Central South University (20160309)
  • the Scientific Research Project of Health and Family Planning Commission of Hunan Province (B20180194)
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
Keywords
exercise therapy, chronic kidney disease, predialysis, estimated glomerular filtration rate, blood pressure, body mass index, serum lipids, triglycerides, serum creatinine, total cholesterol, HDL cholesterol, physical inactivity, cardiovascular risk, renal function, exercise intensity, exercise frequency, exercise mode
MeSH terms
Blood Pressure, Cholesterol, Creatinine, Exercise Therapy, Glomerular Filtration Rate, Humans, Kidney, Lipoproteins, HDL, Lipoproteins, LDL, Triglycerides, Body Mass Index, Randomized Controlled Trials as Topic, Uncertainty, Renal Insufficiency, Chronic

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