Effects of exercise training on proteinuria in adult patients with chronic kidney disease: a systematic review and meta-analysis

Abstract

Background: Rehabilitation effects of exercise training on adults with chronic kidney disease (CKD) have been generally recognised; however, the effects of exercise training on proteinuria have been underexplored. Our aim was to explore the effects of exercise training on proteinuria in adult CKD patients without renal replacement therapy. Methods: Randomised controlled trials (RCTs) and quasi-experimental studies examining the effects of exercise training on proteinuria in adults CKD patients without renal replacement therapy were searched in 10 electronic databases (MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, SPORTDiscus with full text, Web of Science, China Wan Fang Database, China National Knowledge Internet, China Science and Technology Journal Database) until June 2019. The quality of quasiexperimental studies was assessed using the Joanna Briggs Institute Checklist for non-randomised experimental studies. The Cochrane risk of bias tool was used to evaluate the RCT quality. Results: We analysed 11 studies (623 participants). The 24-h urinary protein (24 h UP) level significantly decreased after exercise training in the within-group analysis (standard mean difference [SMD], 0.48; 95% confidence interval [CI], 0.08 to 0.88). There was a slight decrease in 24 h UP levels in the between-group analysis (SMD, 0.91; 95% CI, 0.00 to 1.82); however, the subgroup analysis showed that the change was insignificant (RCT: SMD, 0.24; 95% CI, − 0.44 to 0.92; quasi-experimental studies: SMD, 2.50; 95% CI, − 1.22 to 6.23). Exercise resulted in no significant differences in the urinary albumin-to-creatinine ratio in the between-group analysis (SMD, 0.06; 95% CI, − 0.54 to 0.67), but a significant decrease was found in the within-group analysis (SMD, 0.21; 95% CI, 0.04 to 0.38). No evidence of a decreased urinary protein-to-creatinine ratio was found after exercise (between-group analysis: SMD, 0.08 and 95% CI, − 0.33 to 0.48; within-group analysis: SMD, 0.04; 95% CI, − 0.25 to 0.32). Conclusion: Exercise training does not aggravate proteinuria in adult CKD patients without renal replacement therapy. Further research is warranted in the future to determine the effectiveness of exercise training on proteinuria and to explore the mechanisms by which exercise training influences proteinuria.

The effect of aromatherapy on fatigue in adults receiving haemodialysis treatment: A systematic review and meta‐analysis of randomised controlled trials

“…Therefore, the management of fatigue is important for adults who receive haemodialysis treatment (Ahmady et al, 2019). In recent years, meta‐analyses on fatigue management in adults receiving haemodialysis have shown that nonpharmacological interventions such as exercise and cognitive behavioural therapy are beneficial in fatigue management (Picariello et al, 2018; Song, Lee, et al, 2018; Wu et al, 2020; Yang et al, 2020).…”

The effect of regular aerobic exercise on renal function in patients with CKD: A systematic review and meta-analysis

“…Proteinuria in the obese population was also significantly reduced after exercise intervention. Similarly, Yang et al’s (2020 ) systematic review results suggest that exercise training in adult CKD patients does not aggravate proteinuria, but it is unclear whether there is a positive effect and that low to moderate intensity exercise may reduce proteinuria. The reason for this conclusion may be that CKD patients are usually older, and the included studies mostly selected lower intensity and milder forms of exercise for intervention.…”

Home-Based Exercise in Elderly Patients with Claudication and Chronic Kidney Disease Is Associated with Lower Progressive Renal Function Worsening: A 5-Year Retrospective Study

“…The authors’ conclusion was that exercise therapy may represent a strategy to improve eGFR and targeted risk factors in non-dialysis CKD patients, even in the presence of few studies and a limited number of patients [ 24 ]. Another meta-analysis on adult CKD patients without renal replacement therapy observed that exercise training was safe but had uncertain positive effects on proteinuria [ 41 ]. On the other hand, a low physical function or a poorly active lifestyle may affect renal function and the rate of decline [ 35 ], as observed in older persons [ 22 ], in patients after acute myocardial infarction [ 42 ] or in those with CKD [ 23 ].…”