The Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan (Drs Hama, Ushijima, Nagamatsu, Morita, Yoshimachi, and Kobayashi); TXP Medical Co Ltd, Tokyo, and Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan (Dr Goto); and The Division of Cardiology, Department of Medicine, Tokai University Hospital, Shibuya City, Tokyo, Japan (Dr Ikari).
J Cardiopulm Rehabil Prev. 2022 Mar 1;42(2):E15-E22. doi: 10.1097/HCR.0000000000000651.
Among patients with chronic kidney disease (CKD), little is known about whether the effect of cardiac rehabilitation (CR) on renal function differs across baseline estimated glomerular filtration rate using the serum concentration of cystatin C (eGFRcys). The aim of this study was to evaluate the effect of CR on renal function in patients with CKD.
We performed a retrospective cohort study of patients with CKD (15 ≤ eGFRcys < 60 mL/min/1.73 m2) who participated in our CR program for cardiovascular disease. First, the patients were divided into three groups according to the baseline severity of the eGFRcys: G3a, G3b, and G4 groups. We compared the eGFRcys before and after the CR in each group. Second, to determine the association of baseline eGFRcys with the effect of CR, we fitted a linear regression model using the percent change in the eGFRcys (%ΔeGFRcys) as an outcome.
Of the 203 patients, 122 were in G3a, 60 were in G3b, and 21 were in G4 groups. The mean improvement of eGFRcys in each group was 1.3, 3.1, and 4.8 mL/min/1.73 m2, respectively. The %ΔeGFRcys was larger among patients with lower baseline eGFRcys (0.47% greater improvement of %ΔeGFRcys/one lower baseline eGFRcys; 95% CI, 0.23-0.72%). This association remained significant after adjustment for potential confounders (0.63% greater improvement of %ΔeGFRcys/one lower baseline eGFRcys; 95% CI, 0.35-0.91%).
The effect of CR on renal function was greater in patients with worse renal dysfunction measured by eGFRcys. A CR program could be useful for patients with severe renal dysfunction and it might have a beneficial effect on their renal function.
在慢性肾脏病（CKD）患者中，使用血清胱抑素 C 浓度估计肾小球滤过率（eGFRcys），尚不清楚心脏康复（CR）对肾功能的影响是否因基线时的 eGFRcys 不同而有所差异。本研究旨在评估 CR 对 CKD 患者肾功能的影响。
我们对参加我们的心血管疾病 CR 计划的 CKD（15≤eGFRcys<60mL/min/1.73m2）患者进行了回顾性队列研究。首先，根据基线 eGFRcys 的严重程度将患者分为三组：G3a、G3b 和 G4 组。我们比较了每组 CR 前后的 eGFRcys。其次，为了确定基线 eGFRcys 与 CR 效果的关系，我们使用 eGFRcys 的变化百分比（%ΔeGFRcys）作为因变量拟合线性回归模型。
在 203 名患者中，122 名患者处于 G3a 组，60 名患者处于 G3b 组，21 名患者处于 G4 组。每组 eGFRcys 的平均改善量分别为 1.3、3.1 和 4.8mL/min/1.73m2。基线 eGFRcys 较低的患者%ΔeGFRcys 的改善幅度更大（基线 eGFRcys 每降低 1 个单位，%ΔeGFRcys 的改善幅度增加 0.47%；95%CI，0.23-0.72%）。在校正潜在混杂因素后，这种关联仍然显著（基线 eGFRcys 每降低 1 个单位，%ΔeGFRcys 的改善幅度增加 0.63%；95%CI，0.35-0.91%）。
用 eGFRcys 衡量的肾功能越差的患者，CR 对肾功能的影响越大。CR 计划对肾功能严重受损的患者可能有用，并且可能对其肾功能有有益的影响。
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