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Kidney Week

Abstract: FR-PO539

The Effect of Exercise Intervention on Physical Activity in Patients with Non-Dialysis-Dependent CKD: A Systematic Review

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Author

  • Fujii, Naohiko, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan

Group or Team Name

  • The NDD-CKD Team of the Committee of the Guideline for Renal Rehabilitation
Background

As the population of chronic kidney disease (CKD) grows larger and older worldwide, frailty has become one of emerging problems that may affect the prognosis of patients with CKD and their quality of life. Many observational studies suggest that frailty should be a clinically-relevant mortality risk in both dialysis-dependent and non-dialysis-dependent (NDD) CKD. However, it is not well understood whether this vulnerable state is modifiable by lifestyle intervention, or exercise, in patients with NDD-CKD independent of diet and drug therapy. We performed a systematic review to evaluate the benefits and limitations of exercise intervention among patients with NDD-CKD on exercise tolerance.

Methods

We searched PubMed and the Japanese medical publication library “Ichushi” databases for randomized controlled trials (RCTs) or intervention trials targeting patients with NDD-CKD published until April 2017. Outcomes of interest included indices of exercise tolerance, such as VO2 peak and 6-min walking test (6MWT). Two or three reviewers independently screened the title and abstract of extracted papers from the databases and reviewed the full-text of articles that met the prespecified inclusion and exclusion criteria. Data quality and risk of bias were evaluated by GRADE system. Any disagreements between the reviewers were resolved by discussion. Data syntheses and meta-analyses were performed using Review Manager version 5.3.

Results

After the full-text review of 50 selected articles, 14 RCTs and two intervention trials were included in meta-analysis. Four of them conducted resistance exercise, and others did aerobic exercise or exercise with reduced workload. Nine studies reported changes in VO2 peak, six in 6MWT, and the rest measured other indices. Overall, VO2 peak and 6MWT were significantly improved by 3.2 [inter quartile range (IQR): 1.5 – 5.0] mL/kg/min (N = 296, I2 = 0.67) and 51 [22 - 80] m (N = 241, I2 = 0.27), respectively. There was no report on adverse event regarding exercise intervention.

Conclusion

Moderate exercise intervention among patients with NDD-CKD is beneficial for exercise tolerance measured by VO2 peak and 6MWT. These results should be verified by other objective indices for mobility and in other CKD populations especially with frailty.