Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.
BMC Nephrol. 2020 Nov 11;21(1):475. doi: 10.1186/s12882-020-02110-2.
Aerobic exercise capacity is reduced in non-dialysis chronic kidney disease (CKD), but the magnitude of changes in exercise capacity over time is less known. Our main hypothesis was that aerobic ExCap would decline over 5 years in individuals with mild-to-moderate CKD along with a decline in renal function. A secondary hypothesis was that such a decline in ExCap would be associated with a decline in muscle strength, cardiovascular function and physical activity.
We performed a 5-year-prospective study on individuals with mild-to-moderate CKD, who were closely monitored at a nephrology clinic. Fiftytwo individuals with CKD stage 2-3 and 54 age- and sex-matched healthy controls were included. Peak workload was assessed through a maximal cycle exercise test. Muscle strength and lean body mass, cardiac function, vascular stiffness, self-reported physical activity level, renal function and haemoglobin level were evaluated. Tests were repeated after 5 years. Statistical analysis of longitudinal data was performed using linear mixed models.
Exercise capacity did not change significantly over time in either the CKD group or controls, although the absolute workloads were significantly lower in the CKD group. Only in a CKD subgroup reporting low physical activity at baseline, exercise capacity declined. Renal function decreased in both groups, with a larger decline in CKD (p = 0.05 between groups). Peak heart rate, haemoglobin level, handgrip strength, lean body mass and cardiovascular function did not decrease significantly over time in CKD individuals.
On a group level, aerobic exercise capacity and peak heart rate were maintained over 5 years in patients with well-controlled mild-to-moderate CKD, despite a slight reduction in glomerular filtration rate. In line with the maintained exercise capacity, cardiovascular and muscular function were also preserved. In individuals with mild-to-moderate CKD, physical activity level at baseline seems to have a predictive value for exercise capacity at follow-up.
非透析慢性肾脏病（CKD）患者的有氧运动能力降低，但运动能力随时间的变化程度知之甚少。我们的主要假设是，随着肾功能下降，轻中度 CKD 患者的有氧运动能力（ExCap）将在 5 年内下降。次要假设是，ExCap 的这种下降与肌肉力量、心血管功能和身体活动的下降有关。
我们对在肾病诊所接受密切监测的轻中度 CKD 患者进行了一项为期 5 年的前瞻性研究。共纳入 52 名 CKD 2-3 期患者和 54 名年龄和性别匹配的健康对照者。通过最大循环运动试验评估峰值工作量。评估肌肉力量和瘦体重、心脏功能、血管僵硬、自我报告的身体活动水平、肾功能和血红蛋白水平。5 年后重复测试。使用线性混合模型对纵向数据进行统计分析。
CKD 组和对照组的运动能力在随访期间均无明显变化，尽管 CKD 组的绝对工作量明显较低。仅在基线时报告低身体活动量的 CKD 亚组中，运动能力下降。两组肾功能均下降，CKD 组下降更明显（组间差异为 p=0.05）。CKD 患者的峰值心率、血红蛋白水平、握力、瘦体重和心血管功能在随访期间均无明显下降。
在群体水平上，尽管肾小球滤过率略有下降，但在控制良好的轻中度 CKD 患者中，有氧运动能力和峰值心率在 5 年内保持稳定。与保持的运动能力一致，心血管和肌肉功能也得以保留。在轻中度 CKD 患者中，基线时的身体活动水平似乎对随访时的运动能力具有预测价值。
