Faculty of Medicine, University of La Laguna, Tenerife, Spain,
Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, Tenerife, Spain,
Nephron. 2024;148(2):85-94. doi: 10.1159/000531921. Epub 2023 Aug 23.
Chronic kidney disease (CKD) affects 11-13% of the world population. The main risk factors for CKD include diabetes, hypertension, and obesity. Metabolic syndrome (MS) is associated with the onset of CKD in the nondiabetic population. Obesity and MS are also risk factors for a worse progression of established CKD. Therapeutic exercise is an effective option to treat and manage obesity, MS, and diabetes in the general population. However, the evidence on the effect of exercise on patients with CKD, obesity, and MS is scarce.
We evaluated available evidence on the effect of therapeutic exercise in patients with CKD, excluding dialysis, particularly in improving the metabolic risk factors and main renal outcomes: renal function loss and albuminuria/proteinuria. This review includes prospective studies and clinical trials. A total of 44 studies were analysed in 1,700 subjects with renal disease (2-5), including patients with renal transplantation. Most studies did not prove a major effect of exercise on albuminuria/proteinuria, glomerular filtration rate (GFR), obesity, or MS. These results are intriguing and deserve attention. The exploratory nature of most studies, including a low number of cases and short follow-up, might explain the lack of efficacy of exercise in our analysis. Specific aspects like the type of exercise, frequency, intensity, duration, accommodation during follow-up, individualization, safety, and adherence are crucial to the success of therapeutic exercise. The beneficial role of exercise in patients with CKD remains to be determined.
Key messages of this review are as follows. (1) The effect of therapeutic exercise on renal and metabolic outcomes in patients with CKD remains to be determined. (2) According to the evidence selected, therapeutic exercise seems to be safe to treat patients with CKD. (3) Most studies are exploratory by nature, with results that need further investigation. (4) Therapeutic exercise is a complex procedure that must be specifically designed to treat patients with CKD.
慢性肾脏病（CKD）影响着全球 11-13%的人口。CKD 的主要危险因素包括糖尿病、高血压和肥胖。代谢综合征（MS）与非糖尿病患者 CKD 的发生有关。肥胖和 MS 也是已确诊 CKD 病情恶化的危险因素。运动疗法是治疗和管理普通人群中肥胖、MS 和糖尿病的有效选择。然而，关于运动对 CKD、肥胖和 MS 患者的影响的证据很少。
我们评估了关于 CKD 患者（不包括透析患者）接受运动疗法的疗效的现有证据，尤其是在改善代谢危险因素和主要肾脏结局（肾功能丧失和白蛋白尿/蛋白尿）方面。这篇综述包括前瞻性研究和临床试验。共分析了 44 项涉及 1700 名肾病患者（2-5 期）的研究，包括接受肾移植的患者。大多数研究没有证明运动对白蛋白尿/蛋白尿、肾小球滤过率（GFR）、肥胖或 MS 有重大影响。这些结果令人好奇，值得关注。大多数研究的探索性质，包括病例数量少和随访时间短，可能解释了运动在我们的分析中无效的原因。运动类型、频率、强度、持续时间、随访期间的适应性、个体化、安全性和依从性等具体方面对运动疗法的成功至关重要。运动对 CKD 患者的有益作用仍有待确定。
本综述的关键信息如下。（1）运动疗法对 CKD 患者的肾脏和代谢结局的影响仍有待确定。（2）根据选择的证据，运动疗法似乎对治疗 CKD 患者是安全的。（3）大多数研究的性质都是探索性的，其结果需要进一步研究。（4）运动疗法是一个复杂的过程，必须专门设计以治疗 CKD 患者。
