Veterans Affairs Hospital, Hines, IL, USA.
Cardiovasc Diabetol. 2009 Dec 9;8:62. doi: 10.1186/1475-2840-8-62.
Patients with obesity, diabetes, and chronic kidney disease (CKD) are generally physically inactive, have a high mortality rate, and may benefit from an exercise program.
We performed a 24-week randomized controlled feasibility study comparing aerobic exercise plus optimal medical management to medical management alone in patients with type 2 diabetes, obesity (body mass index [BMI] > 30 kg/m2), and stage 2-4 CKD (estimated glomerular filtration rate [eGFR] 15-90 mL/min/1.73 m2 with persistent proteinuria). Subjects randomized to exercise underwent thrice weekly aerobic training for 6 followed by 18 weeks of supervised home exercise. The primary outcome variable was change in proteinuria.
Seven subjects randomized to exercise and 4 control subjects completed the study. Exercise training resulted in an increase in exercise duration during treadmill testing, which was accompanied by slight but insignificant decreases in resting systolic blood pressure and 24-hour proteinuria. Exercise did not alter GFR, hemoglobin, glycated hemoglobin, serum lipids, or C-reactive protein (CRP). Caloric intake and body weight and composition also did not change with exercise training.
Exercise training in obese diabetic patients with CKD is feasible and may have clinical benefits. A large-scale randomized controlled trial to determine the effects of exercise on renal functions, cardiovascular fitness, inflammation, and oxidative stress in diabetic patients with CKD is planned.
肥胖、糖尿病和慢性肾脏病（CKD）患者通常身体活动不足，死亡率高，可能受益于运动计划。
我们进行了一项为期 24 周的随机对照可行性研究，比较了有氧运动加最佳药物治疗与单纯药物治疗在 2 型糖尿病、肥胖（体重指数[BMI]＞30 kg/m2）和 2-4 期 CKD（估计肾小球滤过率[eGFR]15-90 mL/min/1.73 m2 伴有持续蛋白尿）患者中的疗效。随机分配至运动组的受试者每周进行三次有氧运动训练 6 周，然后进行 18 周的监督家庭运动。主要结局变量是蛋白尿的变化。
7 名随机分配至运动组的受试者和 4 名对照组受试者完成了研究。运动训练导致跑步机测试中运动时间延长，同时静息收缩压和 24 小时蛋白尿略有但无统计学意义的下降。运动并未改变 GFR、血红蛋白、糖化血红蛋白、血脂或 C 反应蛋白（CRP）。运动训练也未改变热量摄入、体重和身体成分。
CKD 肥胖糖尿病患者的运动训练是可行的，可能具有临床益处。计划进行一项大规模的随机对照试验，以确定运动对 CKD 糖尿病患者肾功能、心血管健康、炎症和氧化应激的影响。
