Hou Yi-Chou, Chao Chia-Ter, Shih Li-Jane, Tsai Kuo-Wang, Lin Shyh-Min, Chen Ruei-Ming, Lu Kuo-Cheng
Department of Internal Medicine, Division of Nephrology, Cardinal Tien Hospital, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
Department of Internal Medicine, Nephrology division, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Aging (Albany NY). 2025 Jan 14;17(1):217-231. doi: 10.18632/aging.206177.
Bone turnover markers reflected the bone remodeling process and bone health in clinical studies. Studies on variation of bone remodeling markers in different stage CKD were scant, and this study investigated the role of bedside intradialytic cycling in altering concentrations of bone-remodeling markers in patients with end-stage renal disease (ESRD).
Participants were segmented into four groups: a group with eGFR >60 ml/min/1.73 m, a chronic kidney disease group with eGFR 15-60 mL/min/1.73 m), an ESRD group with an exercise intervention, and an ESRD group with standard care. Comparison of bone turnover markers was performed among groups. The intervention consisting of 12 weeks of intradialytic cycling was performed during dialysis. The variation of bone-remodeling markers was compared between the ESRD with exercise along with the ESRD with standard care after 12-week monitoring.
Bone-formative marker levels (bone-specific alkaline phosphatase and procollagen type 1 amino-terminal propeptide, P1NP) were higher in ESRD patients than in non-ESRD patients and were correlated with indoxyl sulfate and intact parathyroid hormone concentrations ( < 0.05). Postexercise concentrations of tartrate-resistant acid phosphatase-5b ( = 0.003) and N-terminal telopeptide-1 ( = 0.001) had increased in the ESRD patients after 12 weeks of bedside cycling. Bone-formative marker concentration was not altered in the exercise group after cycling.
Bone-formative marker concentrations increased with the severity of chronic kidney disease. Bone formative markers concentration increased along with CKD severity. We demonstrated the bone resorptive markers tartrate-resistant acid phosphatase-5b and N-terminal telopeptide-1 increased after intradialytic cycling in ESRD patients.
在临床研究中，骨转换标志物反映了骨重塑过程和骨骼健康状况。关于不同阶段慢性肾脏病（CKD）患者骨重塑标志物变化的研究较少，本研究旨在探讨床旁透析期间进行周期性运动对终末期肾病（ESRD）患者骨重塑标志物浓度的影响。
参与者被分为四组：估算肾小球滤过率（eGFR）>60 ml/min/1.73 m²的一组、eGFR为15 - 60 mL/min/1.73 m²的慢性肾脏病组、接受运动干预的ESRD组以及接受标准护理的ESRD组。对各组之间的骨转换标志物进行比较。在透析期间进行为期12周的透析期间周期性运动干预。在为期12周的监测后，比较接受运动干预的ESRD组和接受标准护理的ESRD组之间骨重塑标志物的变化。
ESRD患者的骨形成标志物水平（骨特异性碱性磷酸酶和I型前胶原氨基端前肽，P1NP）高于非ESRD患者，且与硫酸吲哚酚和完整甲状旁腺激素浓度相关（P<0.05）。经过12周的床旁周期性运动后，ESRD患者运动后抗酒石酸酸性磷酸酶-5b（P = 0.003）和N端骨桥蛋白-1（P = 0.001）的浓度有所增加。运动组在周期性运动后骨形成标志物浓度未发生改变。
骨形成标志物浓度随慢性肾脏病的严重程度增加而升高。骨形成标志物浓度随CKD严重程度增加而升高。我们证明了ESRD患者在透析期间进行周期性运动后，抗酒石酸酸性磷酸酶-5b和N端骨桥蛋白-1等骨吸收标志物增加。
