Zhang Fan, Bai Yan, Huang Liuyan, Zhong Yifei
Department of Nephrology A, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Ann Med. 2025 Dec;57(1):2458197. doi: 10.1080/07853890.2025.2458197. Epub 2025 Feb 5.
This systematic review and meta-analysis aimed to evaluate differences in cardiopulmonary fitness between healthy controls and children/adolescents with chronic kidney disease (CKD) and the effects of exercise training.
PubMed, Embase, Scopus and Web of Science were searched for published studies from reception to 14 June 2023, and updated search on 15 October 2023. The included observational studies reported on cardiorespiratory fitness, included maximal oxygen uptake (VO), peak oxygen consumption (VO) and 6-minute walk distance (6MWD), in children/adolescents with CKD and age-matched healthy controls, as well as clinical intervention trials of exercise training on cardiorespiratory fitness in samples of children and/or adolescents up to 19.
Fifteen observational studies and five clinical trials were included, respectively. The studies found that the mean cardiopulmonary fitness was 1.82 standardized mean differences (SMDs) units (95% confidence interval (95% CI) 1.43-2.20) lower in children/adolescents with CKD than in healthy controls or reference values. Except for pre-dialysis CKD patients, peritoneal dialysis, haemodialysis and kidney transplant recipients had significantly lower cardiorespiratory fitness than healthy controls. The results of a meta-analysis based on a pre-post single-arm trial showed that compared to baseline, exercise training improved the 6MWD by approximately 58.17 m (95% CI 16.27-100.06), with very low evidence.
This systematic review and meta-analysis of observational studies and clinical trials that included children/adolescents with CKD found that cardiorespiratory fitness is severely reduced in this population and that exercise training may be an effective strategy for improvement. Given the low evidence certainty, additional high-quality trials are necessary.
本系统评价和荟萃分析旨在评估健康对照与慢性肾脏病（CKD）儿童/青少年之间心肺适能的差异以及运动训练的效果。
检索了PubMed、Embase、Scopus和Web of Science数据库，查找从建库至2023年6月14日发表的研究，并于2023年10月15日进行了更新检索。纳入的观察性研究报告了CKD儿童/青少年及年龄匹配的健康对照的心肺适能，包括最大摄氧量（VO）、峰值耗氧量（VO）和6分钟步行距离（6MWD），以及针对19岁及以下儿童和/或青少年样本进行的运动训练对心肺适能的临床干预试验。
分别纳入了15项观察性研究和5项临床试验。研究发现，CKD儿童/青少年的平均心肺适能比健康对照或参考值低1.82个标准化均数差（SMD）单位（95%置信区间（95%CI）为1.43 - 2.20）。除透析前CKD患者外，腹膜透析、血液透析和肾移植受者的心肺适能显著低于健康对照。基于前后单臂试验的荟萃分析结果显示，与基线相比，运动训练使6MWD提高了约58.17米（95%CI为16.27 - 100.06），证据质量极低。
本对包括CKD儿童/青少年的观察性研究和临床试验进行的系统评价和荟萃分析发现，该人群的心肺适能严重降低，运动训练可能是改善心肺适能的有效策略。鉴于证据确定性较低，需要更多高质量试验。
