Petrauskiene Vaida, Hellberg Matthias, Svensson Philippa, Zhou Yunan, Clyne Naomi
Lund University, Skåne University Hospital, Faculty of Medicine, Department of Clinical Sciences Lund, Nephrology, Lund, Sweden.
Clin Kidney J. 2023 Nov 21;17(1):sfad287. doi: 10.1093/ckj/sfad287. eCollection 2024 Jan.
We evaluated the effects of 12 months of exercise training on bone mineral density (BMD) in patients with chronic kidney disease (CKD) stages 3-5 not on kidney replacement therapy (KRT).
A total of 151 patients were randomized to 12 months of either balance or strength training, both together with endurance training. Some 112 patients completed and 107 (69 men, 38 women) were analysed, with a mean age 66 ± 13.5 years and 31% having diabetes. The exercise training was self-administered, prescribed and monitored by a physiotherapist. Total body, hip and lumbar BMD, T score and Z score were measured at baseline and after 12 months using dual energy X-ray absorptiometry.
Both groups showed increased physical performance. The prevalence of osteoporosis and osteopenia was unchanged. The strength group (SG) decreased total body BMD ( < .001), the balance group (BG) increased total body T score ( < .05) and total body Z score ( < .005). Total body ΔT score was negative in the SG and unchanged in the BG ( < .005). Total body ΔZ score was negative in the SG and positive in the BG ( < .001). The proportion of progressors measured by ΔT ( < .05) and ΔZ scores ( < .05) was significantly lower in the BG compared with the SG. In multivariate logistic regression analysis, belonging to the BG was the only factor with a lower risk of deterioration of total body BMD, T and Z scores.
Twelve months of balance training together with endurance training seemed to be superior to strength training in maintaining and improving BMD in patients with CKD not on KRT.
我们评估了为期12个月的运动训练对未接受肾脏替代治疗（KRT）的3 - 5期慢性肾脏病（CKD）患者骨密度（BMD）的影响。
总共151名患者被随机分为接受为期12个月的平衡训练或力量训练组，两组均同时进行耐力训练。约112名患者完成了训练，对其中107名（69名男性，38名女性）进行了分析，平均年龄为66 ± 13.5岁，31%的患者患有糖尿病。运动训练由物理治疗师自行指导、规定和监测。在基线和12个月后使用双能X线吸收法测量全身、髋部和腰椎的骨密度、T值和Z值。
两组的身体机能均有所提高。骨质疏松症和骨质减少症的患病率没有变化。力量训练组（SG）全身骨密度降低（<0.001），平衡训练组（BG）全身T值升高（<0.05），全身Z值升高（<0.005）。SG组全身ΔT值为负，BG组不变（<0.005）。SG组全身ΔZ值为负，BG组为正（<0.001）。与SG组相比，BG组中通过ΔT（<0.05）和ΔZ评分（<0.05）测量的进展者比例显著更低。在多因素逻辑回归分析中，属于BG组是全身骨密度、T值和Z值恶化风险较低的唯一因素。
在未接受KRT的CKD患者中，为期12个月的平衡训练与耐力训练相结合在维持和改善骨密度方面似乎优于力量训练。
