Traise Annette, Dieberg Gudrun, Pearson Melissa Jane, Smart Neil Andrew
Clinical Exercise Physiology, School of Science and Technology, University of New England, Armidale, NSW, 2351, Australia.
J Nephrol. 2024 Nov;37(8):2063-2098. doi: 10.1007/s40620-024-02081-9. Epub 2024 Oct 17.
Chronic kidney disease (CKD) is a global health issue with high mortality and economic costs. Exercise has potential benefits for pre-dialysis CKD management. This review examines the impact of exercise on CKD patients not on dialysis, focusing on improvement in various health parameters. Findings aim to inform the role of exercise in pre-dialysis CKD care.
A systematic search of MEDLINE, EMBASE, the Cochrane Library of Controlled Trials, CINAHL, and SPORTDiscus, up to August 31, 2023, used key terms relating to pre-dialysis CKD and exercise. We pooled randomized controlled trials (RCTs) comparing exercise with usual care and conducted meta-analyses based on a random effects inverse variance model with the effect measure of mean difference.
Of 1162 identified studies, 37 RCTs met the inclusion criteria including 1248 participants. Significant improvements were identified for peak VO mean difference [MD] (2.66 mL/kg/min; 95% confidence interval [CI] 1.48, 3.83; p < 0.00001); the 6-min walk (MD 58.83 m; 95% CI 35.26, 82.41; p < 0.00001), timed up and go (standardised mean difference - 0.35; 95% CI - 0.54, - 0.15; p = 0.0006), 2-min step (MD 57.48 steps; 95% CI 27.80, 87.16; p = 0.0001), and sit to stand tests (MD 4.55 repetitions; 95% CI 1.49, 7.60; p = 0.004); short form [SF]-36 general health (MD 4.26; 95% CI 0.04, 8.47; p = 0.05); SF-36 mental component summary (MD 1.84; 95% CI 0.18, 3.51; p = 0.03); estimated glomerular filtration rate (MD 2.19 mL/min/1.73 m; 95% CI 0.97, 3.50; p = 0.001); serum cystatin-C (MD - 0.06 mg/L; 95% CI - 0.11, - 0.02; p = 0.004); resting heart rate (MD - 1.97 bpm; 95% CI - 3.84, - 0.11; p = 0.04); triglycerides (MD - 12.97mg/dL; 95% CI - 17.30, - 8.63; p < 0.00001); glycosylated haemoglobin (MD - 0.25%; 95% CI - 0.50, - 0.01; p = 0.04); waist circumference (MD - 3.12 cm; 95% CI - 4.37, - 1.86; p < 0.00001); and interleukin-6 (MD - 2.24 pg/mL; 95% CI - 3.87. - 0.61; p = 0.007).
Analysis revealed improvements in aerobic capacity, functional ability, quality of life, estimated glomerular filtration rate, serum cystatin-C, resting heart rate, waist circumference, triglyceride, glycosylated haemoglobin, and interleukin-6 levels.
慢性肾脏病（CKD）是一个全球性的健康问题，死亡率高且经济成本高昂。运动对透析前CKD的管理具有潜在益处。本综述探讨运动对未接受透析的CKD患者的影响，重点关注各种健康参数的改善情况。研究结果旨在为运动在透析前CKD护理中的作用提供依据。
截至2023年8月31日，对MEDLINE、EMBASE、Cochrane对照试验图书馆、CINAHL和SPORTDiscus进行系统检索，使用与透析前CKD和运动相关的关键词。我们汇总了比较运动与常规护理的随机对照试验（RCT），并基于随机效应逆方差模型进行荟萃分析，效应量为平均差。
在1162项已识别的研究中，37项RCT符合纳入标准，包括1248名参与者。发现峰值VO平均差[MD]（2.66 mL/kg/min；95%置信区间[CI] 1.48，3.83；p < 0.00001）、6分钟步行距离（MD 58.83 m；95% CI 35.26，82.41；p < 0.00001）、计时起立行走测试（标准化平均差 -0.35；95% CI -0.54，-0.15；p = 0.0006）、2分钟台阶试验（MD 57.48步；95% CI 27.80，87.16；p = 0.0001）和坐立试验（MD 4.55次重复；95% CI 1.49，7.60；p = 0.004）有显著改善；简短健康调查问卷[SF]-36总体健康状况（MD 4.26；95% CI 0.04，8.47；p = 0.05）；SF-36心理成分汇总（MD 1.84；95% CI 0.18，3.51；p = 0.03）；估计肾小球滤过率（MD 2.19 mL/min/1.73 m²；95% CI 0.97，3.50；p = 0.001）；血清胱抑素-C（MD -0.06 mg/L；95% CI -0.11，-0.02；p = 0.004）；静息心率（MD -1.97次/分钟；95% CI -3.84，-0.11；p = 0.04）；甘油三酯（MD -12.97mg/dL；95% CI -17.30，-8.63；p < 0.00001）；糖化血红蛋白（MD -0.25%；95% CI -0.50，-0.01；p = 0.04）；腰围（MD -3.12 cm；95% CI -4.37，-1.86；p < 0.00001）；以及白细胞介素-6（MD -2.24 pg/mL；95% CI -3.87，-0.61；p = 0.007）有显著改善。
分析显示有氧运动能力、功能能力、生活质量、估计肾小球滤过率、血清胱抑素-C、静息心率、腰围、甘油三酯、糖化血红蛋白和白细胞介素-6水平均有改善。
