Metabolic and hormonal responses to chronic blood-flow restricted resistance training in chronic kidney disease: a randomized trial

Abstract

Maintenance of glycemic and lipemic homeostasis can limit the progression of diabetic kidney disease. Resistance training (RT) is effective in controlling glycemia and lipemia in kidney disease; however, the effect of RT with blood flow restriction (RT+BFR) on these metabolic factors has not been investigated. We aimed to verify if chronic (6 months) RT and RT+BFR performed by patients with stage-2 chronic kidney disease (CKD) improves their glycemic homeostasis and immunometabolic profiles. Patients with CKD under conservative treatment (n = 105 (33 females)) from both sexes were randomized into control (n = 35 (11 females); age 57.6 ± 5.2 years), RT (n = 35 (12 females); age 58.0 ± 6.2 years), and RT+BFR (n = 35 (10 females); 58.0 ± 6.4 years) groups. Chronic RT or RT+BFR (6 months) was performed 3 times per week on non-consecutive days with training loading adjusted every 2 months, RT 50%–60%–70% of 1RM, and RT+BFR 30%–40%+50% of 1RM and fixed repetition number. Renal function was estimated with the glomerular filtration rate and serum albumin level. Metabolic, hormonal, and inflammatory assessments were analyzed from blood samples. Six months of RT and RT+BFR were similarly effective in improving glucose homeostasis and hormone mediators of glucose uptake (e.g., irisin, adiponectin, and sirtuin-1), decreasing pro-inflammatory and fibrotic proteins, and attenuating the progression of estimated glomerular filtration rate. Thus, RT+BFR can be considered an additional exercise modality to be included in the treatment of patients with stage 2 chronic kidney disease. Trial registration number: U1111-1237-8231. URL: http://www.ensaiosclinicos.gov.br/rg/RBR-3gpg5w/ , no. RBR-3gpg5w. Novelty: Glycemic regulation induced by resistance training prevents the progression of CKD. Chronic RT and RT+BFR promote similar changes in glycemic regulation. RT and RT+BFR can be considered as non-pharmacological tools for the treatment of CKD.

Potential implications of blood flow restriction exercise on patients with chronic kidney disease: a brief review

“…These molecular findings reveal promising clinical outcomes considering that both molecules potentially participate in the prospective mortality risk in patients who use dialysis ( Ndrepepa, 2019 ). Furthermore, Deus et al (2022) demonstrated similar benefits of BFR exercise and exercise alone on improving glucose homeostasis by regulation of hormonal mediators of glucose uptake in circulation (e.g., insulin, irisin, adiponectin, and sirtuin 1). In addition, improvements in inflammation and lipid profile were observed within groups with reductions on C-reactive protein and triglycerides levels.…”

A Useful Blood Flow Restriction Training Risk Stratification for Exercise and Rehabilitation

“…Fifty percent (50%) of AOP was applied for the upper and lower limbs in a continuous application method during all exercise training sessions. Chronic effects of resistance training in this population from BFRT compared to traditional training include increased angiotensin 1-7, NO2-, increased antioxidant defense, decreased pro-oxidative markers, increased catalase activity, improved glucose homeostasis and hormones mediators of glucose uptake, and improved cardiac autonomic function (Correa et al, 2021a,b;de Deus et al, 2021;Deus et al, 2022). At the same time, BFRT diminished vasopressin levels and attenuated the decrease of estimated glomerular filtration, implying positive post-exercise benefits.…”

“…BFRT may become a potentially valuable tool for chronic kidney disease (CKD) patients as they present low tolerance to heightened perceptual demands of exercise training ( Correa et al, 2021a , b ; de Deus et al, 2021 ; Deus et al, 2022 ). Randomized controlled trials using the same protocol compared the effects of 6 months of periodized resistance training with and without BFRT 3 days a week in male and female patients with stage 2 CKD with hypertension and DM.…”

“…BFRT may become a potentially valuable tool for chronic kidney disease (CKD) patients as they present low tolerance to heightened perceptual demands of exercise training (Correa et al, 2021a,b;de Deus et al, 2021;Deus et al, 2022). Randomized controlled trials using the same protocol compared the effects of 6 months of periodized resistance training with and without BFRT 3 days a week in male and female Fall in systolic blood pressure below resting levels during exercise; Non-sustained ventricular tachycardia with exercise; Previous episode of primary cardiac arrest (e.g., cardiac arrest that did not occur in the presence of an acute myocardial infarction or during a cardiac procedure); SBP ≥ 160 mmHg and/or DBP ≥ 100 mmHg prior to exercise; Uncontrolled hypertension (>180/110 mmHg); SBP between 160 and 179 mmHg or DBP between 100 and 109 mmHg with the presence of 1 cardiovascular risk factor a , with target organ damage b , chronic kidney disease or diabetes mellitus;…”

“…At the same time, BFRT diminished vasopressin levels and attenuated the decrease of estimated glomerular filtration, implying positive post-exercise benefits. Also, improved uremic parameters and inflammation profile (e.g., interleukin-6, IL-10, IL-15, IL-17a, IL-18, klotho, C-reactive protein, and tumor necrosis factor-alpha) was observed in the BFRT group indicating downregulation of inflammation-related markers and a decreasing of fibroblast growth factor 23 (marker of renal deterioration)-klotho axis (Correa et al, 2021a,b;Deus et al, 2022).…”