Sports Medicine Laboratory, Aristotle University of Thessaloniki, Aristotle University of Thessaloniki, DPESS, Laboratory Building, TEFAA, Thermi, PC 57001, Thessaloniki, Greece.
Department of Sport, Exercise and Health, Sports and Exercise Medicine, Medical Faculty, University of Basel, Basel, Switzerland.
Eur J Prev Cardiol. 2024 Sep 6;31(12):1493-1515. doi: 10.1093/eurjpc/zwae130.
Cardiovascular (CV) morbidity and mortality is high in patients with chronic kidney disease (CKD). Most patients reveal a high prevalence of CV risk factors such as diabetes or arterial hypertension and many have manifest cardiovascular disease (CVD), such as coronary artery disease and chronic heart failure with an increased risk of clinical events including sudden cardiac death. Diabetes mellitus and hypertension contribute to the development of CKD and the prevalence of CKD is in the range of 20-65% in diabetic and 30-50% in hypertensive patients. Therefore, prevention and optimal treatment of CV risk factors and comorbidities are key strategies to reduce CV risk and improve survival in CKD. Beyond common CV risk factors, patients with CKD are often physically inactive and have low physical function leading to subsequent frailty with muscle fatigue and weakness, sarcopenia and increased risk of falling. Consequently, the economic health burden of CKD is high, requiring feasible strategies to counteract this vicious cycle. Regular physical activity and exercise training (ET) have been shown to be effective in improving risk factors, reducing CVD and reducing frailty and falls. Nonetheless, combining ET and a healthy lifestyle with pharmacological treatment is not frequently applied in clinical practice. For that reason, this Clinical Consensus Statement reviews the current literature and provides evidence-based data regarding the role of ET in reducing CV and overall burden in patients with CKD. The aim is to increase awareness among cardiologists, nephrologists, and healthcare professionals of the potential of exercise therapy in order to encourage implementation of ET in clinical practice, eventually reducing CV risk and disease, as well as reducing frailty in patients with CKD G3-G5D.
心血管疾病（CV）发病率和死亡率在慢性肾脏病（CKD）患者中较高。大多数患者存在较高的心血管危险因素患病率，如糖尿病或动脉高血压，许多患者存在明显的心血管疾病（CVD），如冠状动脉疾病和慢性心力衰竭，临床事件风险增加，包括心源性猝死。糖尿病和高血压导致 CKD 的发生，在糖尿病患者中 CKD 的患病率为 20-65%，在高血压患者中为 30-50%。因此，预防和优化心血管危险因素和合并症的治疗是降低 CKD 患者心血管风险和改善生存的关键策略。除了常见的心血管危险因素外，CKD 患者通常身体活动不足，身体功能低下，导致随后出现肌肉疲劳和无力、肌肉减少症和跌倒风险增加的虚弱。因此，CKD 的经济健康负担很高，需要可行的策略来对抗这种恶性循环。定期进行身体活动和运动训练（ET）已被证明可有效改善危险因素、降低 CVD 风险以及减少虚弱和跌倒。尽管如此，将 ET 与健康的生活方式和药物治疗相结合在临床实践中并不常见。因此，本临床共识声明回顾了当前的文献，并提供了关于 ET 在降低 CKD 患者心血管和整体负担方面作用的循证数据。目的是提高心脏病专家、肾脏病专家和医疗保健专业人员对运动疗法潜力的认识，以鼓励在临床实践中实施 ET，最终降低 CKD G3-G5D 患者的心血管风险和疾病，并减少虚弱。
