Effects of aerobic exercise on vascular function in nondialysis chronic kidney disease: a randomized controlled trial

Abstract

Endothelial dysfunction and arterial stiffness are nontraditional risk factors of chronic kidney disease (CKD)-related cardiovascular disease (CVD) that could be targeted with exercise. This study investigated the effect of moderate to vigorous aerobic exercise on vascular function in nondialysis CKD. In this randomized, controlled trial, 36 nondialysis patients with CKD (means ± SE, age: 58 ± 2 yr, estimated glomerular filtration rate: 44 ± 2 ml·min−1·1.73 m−2) were allocated to an exercise training (EXT) or control (CON) arm. The EXT group performed 3 × 45 min of supervised exercise per week at 60–85% heart rate reserve for 12 wk, whereas the CON group received routine care. Outcomes were assessed at 0 and 12 wk. The primary outcome, microvascular function, was assessed via cutaneous vasodilation during local heating measured by laser-Doppler flowmetry coupled with microdialysis. Participants were instrumented with two microdialysis fibers for the delivery of 1) Ringer solution and 2) the superoxide scavenger tempol. Conduit artery function was assessed via brachial artery flow-mediated dilation. Aortic pressure waveforms and pulse wave velocity were acquired with tonometry and oscillometry. Microvascular function improved after EXT ( week 0 vs . week 12, EXT: 87 ± 2% vs. 91 ± 2% and CON: 86 ± 2% vs. 84 ± 3%, P = 0.03). At baseline, pharmacological delivery of tempol improved microvascular function (Ringer solution vs. tempol: 86 ± 1% vs. 90 ± 1%, P = 0.02) but was no longer effective after EXT (91 ± 2% vs. 87 ± 1%, P = 0.2), suggesting that an improved redox balance plays a role in EXT-related improvements. Brachial artery flow-mediated dilation was maintained after EXT (EXT: 2.6 ± 0.4% vs. 3.8 ± 0.8% and CON: 3.5 ± 0.6% vs. 2.3 ± 0.4%, P = 0.02). Central arterial hemodynamics and arterial stiffness were unchanged after EXT. Aerobic exercise improved microvascular function and maintained conduit artery function and should be considered as an adjunct therapy to reduce CVD risk in CKD.

Effects of exercise on kidney and physical function in patients with non-dialysis chronic kidney disease: a systematic review and meta-analysis

“…Blinding of participants was not possible due to the nature of exercise training. Three trials 17,32,36 showed high risks of bias related to the…”

“…However, the review had included non-RCT studies 44,45 , and some study participants were included more than twice in the meta-analysis; this may have resulted in selection bias and the overestimation of the effect of exercise on kidney function. Some studies showed that exercise training improved vascular function, attenuated the increase in sympathetic nervous system activity, and reduced blood pressure in patients with non-dialysis CKD 17,18,28,33,35,38,44 . This supports the hypothesis that exercise training could delay the decline in kidney function.…”

Chronic statin therapy is associated with enhanced cutaneous vascular responsiveness to sympathetic outflow during passive heat stress

“…; Kirkman et al . ). Because integrated bursts of SSNA occur with varying widths and can contain multiple peaks, the calculation of burst frequency is not feasible (Hagbarth et al .…”

“…Cutaneous vascular conductance (CVC) was calculated as red cell flux (perfusion units; PU) divided by mean arterial pressure and expressed as a percentage of maximum vasodilatation. To account for heterogeneity in vessel density across the cutaneous vascular bed, this normalization scheme is commonly used for laser Doppler flowmeter-derived data when there are no differences in maximum vasodilatation between groups (Wardell et al 1994;Stanhewicz et al 2016;Kirkman et al 2019). Because integrated bursts of SSNA occur with varying widths and can contain multiple peaks, the calculation of burst frequency is not feasible (Hagbarth et al 1972;.…”

Beneficios del ejercicio en el envejecimiento y patologías asociadas.

“…En un estudio se valoró el impacto del ejercicio físico en este tipo de pacientes y luego de 6 meses se comprobó que los pacientes tenían una mejor función cognitiva preservando sus funciones mentales superiores y además otro beneficio que se obtiene es el aumento en la masa muscular (24)(25)(26). Por otra parte, pacientes con Enfermedad Renal Crónica que no se sometieron a diálisis pero sí a una régimen de 12 días y realizando ejercicio aeróbico moderado obtuvieron una mejoría en su condición cardiovascular, una estabilidad de su función endotelial y la mejoría en la función microvascular sin traducir esto a una disminución de la rigidez endotelial (27).…”