Yamamoto Ryohei, Ito Takafumi, Nagasawa Yasuyuki, Matsui Kosuke, Egawa Masahiro, Nanami Masayoshi, Isaka Yoshitaka, Okada Hirokazu
Health and Counseling Center, Osaka University, 1-17 Machikaneyama-cho, Toyonaka, Osaka, 560-0043, Japan.
Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan.
J Nephrol. 2021 Feb;34(1):155-164. doi: 10.1007/s40620-020-00865-3. Epub 2021 Jan 2.
Several randomized controlled trials (RCTs) have demonstrated the cardiometabolic effects of aerobic exercise in the general population and in patients with cardiovascular diseases. However, the efficacy of aerobic exercise in patients with chronic kidney disease (CKD) remains to be elucidated.
RCTs comparing aerobic exercise with no aerobic exercise in patients with CKD not requiring kidney replacement therapy were identified through PubMed using RobotAnalyst, a web-based software system that combines text-mining and machine learning algorithms for organizing references. Cardiometabolic and renal outcomes of interest included body mass index (BMI); systolic blood pressure (SBP); hemoglobin A1c (HbA1c), total cholesterol (TCHO), low- and high- density lipoprotein cholesterol (LDLC and HDLC, respectively), and urinary protein (UP) levels/concentration; peak oxygen uptake (Vopeak); and glomerular filtration rate (GFR) at the end of the follow-up period. The standardized mean difference (SMD) of each outcome was estimated using the DerSimonian-Laird random-effect model with inverse-variance weighting.
A total of 15 trials, including 622 patients, were included. Their follow-up periods were 3-4, 6-12, and > 12-months in 7 (46.7%), 7 (46.7%), and 1 (6.7%) trial(s), respectively. Meta-analyses showed that aerobic exercise significantly decreased BMI (SMD, -0.19 [95% confidence interval, -0.38, -0.00]) and SBP (-0.75 [-1.24, -0.26]) and increased Vopeak (0.54 [0.29, 0.78]); however, no significant association was observed in HbA1c, TCHO, HDLC, LDLC, GFR, and UP. Meta-regression models suggested that aerobic exercise was more likely to improve Vopeak in patients with younger age, no diabetes, and lower BMI.
Aerobic exercise of 3-12 months' duration improved obesity, high blood pressure, and low exercise capacity in overweight/obese patients with CKD, but it had no significant effect on GFR and proteinuria. Well-designed large RCTs with a longer follow-up period are needed to evaluate the efficacy of aerobic exercise in patients with CKD.
多项随机对照试验（RCT）已证实有氧运动对普通人群和心血管疾病患者的心脏代谢效应。然而，有氧运动对慢性肾脏病（CKD）患者的疗效仍有待阐明。
通过PubMed使用RobotAnalyst识别在不需要肾脏替代治疗的CKD患者中比较有氧运动与无有氧运动的RCT，RobotAnalyst是一种基于网络的软件系统，结合文本挖掘和机器学习算法来整理参考文献。感兴趣的心脏代谢和肾脏结局包括体重指数（BMI）；收缩压（SBP）；糖化血红蛋白（HbA1c）、总胆固醇（TCHO）、低密度和高密度脂蛋白胆固醇（分别为LDLC和HDLC）以及尿蛋白（UP）水平/浓度；峰值摄氧量（Vopeak）；以及随访期末的肾小球滤过率（GFR）。使用具有逆方差加权的DerSimonian-Laird随机效应模型估计每个结局的标准化平均差（SMD）。
共纳入15项试验，包括622例患者。其随访期分别为3 - 4个月、6 - 12个月和＞12个月的试验有7项（46.7%）、7项（46.7%）和1项（6.7%）。荟萃分析表明，有氧运动显著降低BMI（SMD，-0.19 [95%置信区间，-0.38，-0.00]）和SBP（-0.75 [-1.24，-0.26]）并增加Vopeak（0.54 [0.29，0.78]）；然而，在HbA1c、TCHO、HDLC、LDLC、GFR和UP方面未观察到显著关联。荟萃回归模型表明，有氧运动在年龄较小、无糖尿病且BMI较低的患者中更有可能改善Vopeak。
为期3 - 12个月的有氧运动改善了超重/肥胖CKD患者的肥胖、高血压和低运动能力，但对GFR和蛋白尿无显著影响。需要设计良好且随访期更长的大型RCT来评估有氧运动对CKD患者的疗效。
