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Kidney Week

Abstract: PO2061

Home-Based Aerobic Exercise and Resistance Training in Pre-Dialysis Patients with Advanced CKD: A Randomized Controlled Trial

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • Uchiyama, Kiyotaka, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
  • Adachi, Keika, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
  • Wakino, Shu, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
  • Itoh, Hiroshi, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
Background

Muscle wasting, a common and progressive condition in patients with uremia, is associated with increased risk for morbidity, lower health-related quality of life (HRQOL), and mortality. But, the potential effects of aerobic and resistance training in predialysis patients with advanced chronic kidney disease (CKD) have not been fully elucidated. This randomized controlled trial with a parallel-group design investigated the effects of a home-based exercise program on physical functioning and HRQOL in patients with stage 4 CKD.

Methods

A total of 46 patients (median age, 73 years; 33 males; estimated glomerular filtration rate, 23.2 ± 4.7 ml/min/1.73 m2) were randomly assigned to exercise (n = 23) and control (n = 23) groups. The exercise group performed aerobic exercise thrice weekly and resistance training twice weekly at home for 24 weeks. The control group received no specific intervention. Primary outcomes were distance in incremental shuttle walking test (ISWT) and HRQOL assessed by the Kidney Disease Quality of Life-Short Form questionnaire. Secondary outcomes were kidney function assessed by combined urea and creatinine clearance, urinary biomarkers, and anthropometric/biochemical parameters associated with CKD.

Results

ISWT distance was significantly improved in the exercise group than in the control group (34.5 ± 50.5 vs. −21.9 ± 48.2 m; P < 0.001). The intervention increased several HRQOL subscales including symptoms/problems, quality of interaction, sleep, kidney disease component summary, and mental health. Although the change in combined urea and creatinine clearance was not significantly different between the groups (P = 0.69), natural log-transformed (ln) urinary excretion of liver-type fatty acid-binding protein, ln serum C-reactive protein, and acylcarnitine/free carnitine ratio were significantly decreased in the exercise group compared to the control group (P = 0.02, 0.005, and 0.03, respectively). No adverse events associated with the intervention were reported.

Conclusion

The 24-week home-based exercise program improved aerobic capacity and HRQOL with possible beneficial effects on kidney function and CKD-related parameters, in patients with stage 4 CKD. The present trial demonstrated the multifaceted efficacy of home-based training on predialysis patients with advanced-stage CKD.