The effect of the physical activity on polymorphic premature ventricular complexes in chronic kidney disease
Open accessAbstract
BACKGROUND: Polymorphic premature ventricular complexes (PVCs) are very common, appearing most frequently in patients with hypertension, obesity, sleep apnea, and structural heart disease. Sympathetic hyperactivity plays a critical role in the development, maintenance, and aggravation of ventricular arrhythmias. Endurance exercise training clearly lowers sympathetic activity in sympatho-excitatory disease states and may be tolerated by patients with chronic kidney disease (CKD). METHODS: We assessed 40 CKD patients with hypertension with polymorphic PVCs. Patients underwent a complete medical history and physical examination. We evaluated the effectiveness of β blocker only or β blocker + exercise during 12 months of follow-up regarding the changes of the numbers of PVCs and mean heart rate (HR) by 24-hour-Holter. RESULTS: < 0.001) months. There was an improvement during the 12 months of follow-up vs. baseline, after the β blocker or β blocker + exercise in mean 24-hour HR Holter monitoring, creatinine values, eGFR, and ACR. CONCLUSION: Polymorphic PVCs may be modifiable by physical activity in CKD patients with hypertension without structural heart disease.
AI snapshot
Written from the paper’s full text.
TL;DR
In 40 CKD patients with controlled hypertension and polymorphic PVCs, adding physical activity to β blocker therapy reduced polymorphic PVC burden more than β blocker alone over 12 months. The authors conclude polymorphic PVCs may be modifiable by physical activity in CKD patients with hypertension without structural heart disease.
Key findings
- In the β blocker group, polymorphic PVCs decreased from baseline 36,515 ± 3,518 to 28,314 ± 2,938 at 3 months, 23,709 ± 1,846 at 6 months, 22,564 ± 1,673 at 9 months, and 22,725 ± 1,415 at 12 months (P < 0.001 for all comparisons vs. baseline).
- In the β blocker + exercise group, polymorphic PVCs decreased from baseline 36,091 ± 3,327 to 29,252 ± 3,211 at 3 months, 20,948 ± 2,386 at 6 months, 14,238 ± 3,338 at 9 months, and 6,225 ± 2,319 at 12 months (P < 0.001 for all comparisons vs. baseline).
- Between-group differences appeared from the sixth month onward: 6th month Δ = −2,761 (P = 0.045), 9th month Δ = −8,325 (P < 0.001), and 12th month Δ = −16,500 (P < 0.001).
- A significant correlation was found between the change in polymorphic PVCs at 12 months and total weekly exercise time (r = −0.933, 95% CI −0.974 to −0.836, P < 0.001). The paper also reports improvements in mean 24-hour Holter HR, creatinine, eGFR, and ACR, displayed in Table 2.
Methods
- Prospective, longitudinal study of 40 CKD, controlled hypertensive, sedentary patients with polymorphic PVCs; all started bisoprolol 10 mg, with 20 remaining sedentary and 20 beginning physical activity (150 minutes/week moderate activity, increasing progressively to 300 minutes/week moderate-to-intensive exercise).
- Patients were recruited from January 2014 to December 2015 at Hospital e Clínica São Gonçalo, Rio de Janeiro, Brazil; inclusion required structurally normal heart, LV ejection fraction > 50%, > 25,000 polymorphic PVCs on baseline 24-hour Holter, eGFR < 60 mL/min/1.73 m², and symptoms.
- Follow-up was quarterly over 12 months; outcomes included polymorphic PVC count and mean HR by 24-hour Holter, renal function (creatinine, eGFR, ACR), and baseline ABPM/echocardiography. Statistical tests included paired t-test or Wilcoxon, repeated-measures ANOVA or Kruskal–Wallis ANOVA, Fisher’s exact test, and Pearson or Spearman correlation, with P < 0.05 significant.
Limitations
- The authors state that cardiac magnetic resonance was not used because gadolinium could lead to nephrogenic systemic fibrosis in the CKD population.
- The authors state that findings should be interpreted cautiously because the study was unblinded and non-randomised, and that a randomised trial with treatment concealment, more patients, and longer follow-up is required.
- The authors state that the data are preliminary and need validation in a large population and in the long term; the text also makes evident that this was a single-centre study with only 20 patients per group.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
3 of 11 cited sources checked · 2 supported · 0 flagged · accuracy not yet measured
- Findingown data
In the β blocker + exercise group of CKD hypertensive patients with polymorphic PVCs, the number of polymorphic PVCs decreased significantly from baseline (36,091 ± 3,327) to 3, 6, 9 and 12 months of follow-up (29,252 ± 3,211; 20,948 ± 2,386; 14,238 ± 3,338; 6,225 ± 2,319), with P < 0.001 for all comparisons of each time point vs baseline.
“In the β blocker + exercise group a significant decrease in the number of polymorphic PVCs also occurred from baseline 36,091 ± 3,327 to 3, 6, 9 and 12 months of follow-up, 29,252 ± 3,211, 20,948 ± 2,386, 14,238 ± 3,338, and 6,225 ± 2,319, respectively (P < 0.001 to all the comparisons between the mean of each time point vs. baseline) as shown in Fig. 1.”
Quote in the paperSubstantial claim - Findingown data
In the β blocker group of CKD hypertensive patients with polymorphic PVCs, the number of polymorphic PVCs decreased significantly from baseline (36,515 ± 3,518) to 3, 6, 9 and 12 months of follow-up (28,314 ± 2,938; 23,709 ± 1,846; 22,564 ± 1,673; 22,725 ± 1,415), with P < 0.001 for all comparisons of each time point vs baseline.
“We observed in the β blocker group a significant decrease in the number of polymorphic PVCs from baseline 36,515 ± 3,518 to 3, 6, 9 and 12 months of follow-up, 28,314 ± 2,938, 23,709 ± 1,846, 22,564 ± 1,673, and 22,725 ± 1,415, respectively (P < 0.001 to all the comparisons between the mean of each time point vs. baseline).”
Quote in the paperSubstantial claim - Findingown data
A significant correlation was found between the variation (Δ) in the number of polymorphic PVCs at the 12th month after the onset of physical activity and the total time of exercise performed per week (r = −0.933, 95% CI −0.974 to −0.836, P < 0.001).
“A significant correlation was found between the variation (Δ) number of polymorphic PVCs at the 12th month (r = −0.933, 95% confidence interval = −0.974 to −0.836, P < 0.001) after the onset of physical activity and the total time of exercise performed per week, as shown in Fig. 2.”
Quote in the paperSubstantial claim - Premisecitation
Sympathetic hyperactivity plays a critical role in the development, maintenance, and aggravation of ventricular arrhythmias.
“Sympathetic hyperactivity plays a key title role in the development, maintenance, and aggravation of ventricular arrhythmias [11].”
- Also stated in: § Discussion · plain
“Sympathetic overactivity plays a critical role in the development, maintenance, and aggravation of ventricular arrhythmias [11].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [11] Leenen, FH (1999). Cardiovascular consequences of sympathetic hyperactivity. Can J Cardiol. <em>15</em>, 2A-7A.
- Also stated in: § Discussion · plain
- Interpretationown data
Polymorphic PVCs may be modifiable by physical activity in CKD patients with hypertension without structural heart disease.
“Polymorphic PVCs may be modifiable by physical activity in CKD patients with hypertension without structural heart disease.”
- Also stated in: § Discussion · hedged
“In conclusion, polymorphic PVCs may be modifiable by physical activity in CKD patients with hypertension without structural heart disease according to the aforementioned results.”
Quote in the paperSubstantial claim- Rests on an assumption: The β blocker group and the β blocker + exercise group were comparable at baseline despite the non-randomised allocation.
- Also stated in: § Discussion · hedged
- May combine two claims. 7
- Classified as probably not a substantial claim. 6
- The quote only partly states this claim. 1
May combine two claims.
PremisecitationEndurance exercise training lowers sympathetic activity in sympatho-excitatory disease states and is well-tolerated by patients with chronic kidney disease.
“Endurance exercise training obviously lowers sympathetic activity in sympatho-excitatory disease states [13,14] and is well-tolerated by patients with chronic kidney disease (CKD) [15,16].”
Quote in the paperSubstantial claim1 of 4 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationPVCs in the structurally normal heart are considered benign, though they have been associated with a more than two-fold higher risk of cardiovascular complications, including stroke and death.
“In general, PVCs in the structurally normal heart are considered benign [2], though they have been associated with a more than two-fold higher risk of cardiovascular complications, including stroke [3] and death [4].”
Quote in the paperNot a substantial claim1 of 3 sources checked- cites [2] source
- cites [3] source
Citation [3] is attached to the stroke association, not the statements about benign PVCs or death. The Results report a more than two-fold stroke hazard for participants without major stroke risk factors (HR 2.09), but not for the cohort overall (unadjusted HR 1.71; age-, gender-, and race-adjusted HR 1.4). The sentence omits the subgroup qualification needed for its magnitude claim. No page numbers are supplied for these passages. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [4] source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPremature ventricular complexes are very common, appearing most frequently in patients with hypertension, obesity, sleep apnea, and structural heart disease.
“Premature ventricular complexes (PVCs) are very common, appearing most frequently in patients with hypertension, obesity, sleep apnea, and structural heart disease [1].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [1] source
May combine two claims.
Findingown dataComparisons between the β blocker and β blocker + exercise groups at the same time point showed differences in polymorphic PVC numbers from the sixth month onwards: 6th month (Δ = −2,761, P = 0.045), 9th month (Δ = −8,325, P < 0.001) and 12th month (Δ = −16,500, P < 0.001).
“Comparisons between the two groups at the same time point just showed differences from the sixth month onwards: at the 6th (Δ = −2,761, P = 0.045), 9th (Δ = −8,325, P < 0.001) and 12th (Δ = −16,500, P < 0.001) months.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataDuring the 12 months of follow-up vs baseline, after β blocker or β blocker + exercise, there was an improvement in mean 24-hour HR Holter monitoring, creatinine values, eGFR, and ACR.
“There was an improvement during the 12 months of follow-up vs. baseline, after the β blocker or β blocker + exercise in mean 24-hour HR Holter monitoring, creatinine values, eGFR, and ACR.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationThe effect of endurance training on renal sympathetic nerve activity has been measured in healthy humans but not in humans with CKD.
“The outcome of endurance training on renal sympathetic nerve activity has been measured in healthy humans [17], but not in humans with CKD.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] source
Classified as probably not a substantial claim.
Study design and conductreasoningThe study was unblinded and non-randomised, so the findings comparing the β blocker + exercise group with the β blocker group should be interpreted with caution.
“Whilst there was an improvement in the number of polymorphic PVCs, and renal function in the β blocker + exercise group in comparison to β blocker group, these findings should be interpreted with caution given the unblinded non-randomised nature of the study.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataLong-term exercise can reduce ventricular arrhythmias and improve renal function in CKD patients.
“In conclusion, our data suggest that the long-term exercise can reduce ventricular arrhythmias and improve the renal function.”
Quote in the paperSubstantial claim- Rests on an assumption: The β blocker group and the β blocker + exercise group were comparable at baseline despite the non-randomised allocation.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe echocardiographic data were analyzed and interpreted by one experienced echocardiographer who was blinded to treatment status and imaging sequence.
“Data were analyzed and interpreted by one experienced echocardiographer who was blinded to treatment status and imaging sequence.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationABPM monitoring was repeated as necessary until at least 70% of the measured values obtained during both daytime and nighttime were satisfactory.
“Monitoring was repeated as necessary until ≥ 70% of the measured values obtained during both daytime and nighttime were satisfactory [20].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [20] source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims. The quote only partly states this claim.
Study design and conductnone givenThe study was conducted in accordance with the Helsinki Declaration and approved by the Ethics Committee of Hospital e Clínica São Gonçalo (HCSG2013-004).
“The study was piloted in accordance with the Helsinki Declaration and approved by the Ethics Committee of Hospital e Clínica São Gonçalo (HCSG2013-004).”
Quote in the paperNot a substantial claim
The paper relies on this without support.
The β blocker group and the β blocker + exercise group were comparable at baseline despite the non-randomised allocation.
“However 20 patients remained sedentary, serving as a control group, and the other 20 subjects began to practice physical activity (starting with 150 minutes of moderate activity per week, as recommended by the Brazilian Ministry of Health, and increasing progressively until 300 minutes of moderate to intensive exercise per week).”
Claims other papers make about this one
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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].”
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 [15]
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 [15]
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“cardiovascular and kidney disease reportedly have higher morbidity and mortality rates when physically inactive [2, 3].”
Background
- Authors
- Kiuchi, M. G., & Chen, S.
- Affiliations
- Division of Cardiac Surgery and Artificial Cardiac Stimulation, Department of Medicine, Hospital e Clínica São Gonçalo, São Gonçalo, RJ, Brazil
- Shanghai Jiao Tong University (CN)
- Venue
- Kidney Research and Clinical Practice
- Publisher
- The Korean Society of Nephrology
- Published
- 2017-06-30
- Volume
- 36
- Issue
- 2
- Pages
- 167-174
- ISSN
- 2211-9132 (ISSN-L)
- 2211-9140
- PMC
- PMC5491163
- OpenAlex
- W2688568970
- Cited by
- 4
- References
- 36
- Citations by year
- 2022: 1 · 2020: 2 · 2019: 1
- FWCI
- 0.54
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Kidney Research and Clinical Practice (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (submittedVersion, cc-by-nc)
- PubMed Central (submittedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- chronic kidney disease, physical activity, endurance training, beta-blockers, hypertension, ventricular arrhythmias, sympathetic hyperactivity, heart rate, 24-hour Holter monitoring, estimated glomerular filtration rate, albumin-creatinine ratio
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