A Case-control Study of Exercise and Kidney Disease: Hemodialysis and Transplantation

Abstract

We aimed to analyze the effect of an exercise training program in autonomic modulation, and exercise tolerance of hemodialysis and kidney-transplanted patients. 4 groups of exercised and non-exercised patients undergoing hemodialysis and kidney-transplanted subjects had their biochemical tests, and heart rate variability evaluations analyzed. Also, sleep quality, anxiety and depression questionnaires were evaluated. Both exercised groups showed improvements in cardiovascular autonomic modulation, biochemical markers, and exercise tolerance after the exercise training program. The exercised kidney-transplanted patients group showed better improvements in cardiovascular autonomic modulation, biochemical markers, and exercise tolerance when compared to the exercised hemodialysis patients group. Both groups showed improvements in sleep quality, anxiety, and depression. The group of kidney-transplanted patients show better results in the cardiovascular autonomic modulation than subjects undergoing hemodialysis. However, the patients undergoing hemodialysis showed improvements in blood pressure, HDL, hemoglobin and phosphorus, changes not observed in the kidney-transplanted group. Exercise is beneficial for both hemodialysis and kidney-transplanted patients groups. However, exercise programs should be focused mainly in improving cardiovascular risk factors in the HD patients.

Key words

exercise - chronic kidney disease - kidney replacement therapy - heart rate variability

• References

• 1 Barroso R, Silva-Filho AC, Dias CJ, Soares N Jr, Mostarda A, Azoubel LA, Melo L, Garcia A, de MC, Rodrigues B, Mostarda CT. Effect of exercise training in heart rate variability, anxiety, depression, and sleep quality in kidney recipients: A preliminary study. J Health Psychol 2016; 1:1359105316676329
• 2 Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation; 1996
• 3 Bossola M, Ciciarelli C, Conte GL, Vulpio C, Luciani G, Tazza L. Correlates of symptoms of depression and anxiety in chronic hemodialysis patients. Gen Hosp Psychiatry 2010; 32: 125-131
• 4 Brotman DJ, Bash LD, Qayyum R, Crews D, Whitsel EA, Astor BC, Coresh J. Heart Rate Variability Predicts ESRD and CKD-Related Hospitalization. J Am Soc Nephrol 2010; 21: 1560-1570
• 5 Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213
• 6 Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd Edition. Lawrence Erlbaum Associates,1988
• 7 Cukor D, Coplan J, Brown C, Friedman S, Cromwell-Smith A, Peterson RA, Kimmel PL. Depression and anxiety in urban hemodialysis patients. Clin J Am Soc Nephrol 2007; 2: 484-490
• 8 Dias CJ, Anaisse-Azoubel LM, Cristina E, de Lima Carneiro R, Rodrigues B, Silva-Filho AC, Irigoyen MC, Dias-Filho CAA, Navarro F, Sevílio M, Mostarda CT. Comparison of Baroreflex response to acute sessions of strength and aerobic exercises in kidney recipients. J Exerc Physiol Online 2017; 20: 123-133
• 9 Egbuna OI, Taylor JG, Bushinsky DA, Zand MS. Elevated calcium phosphate product after renal transplantation is a risk factor for graft failure. Clin Transplant 2007; 21: 558-566
• 10 Enright PL. The six-minute walk test. Respir Care 2003; 48: 783-785
• 11 Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 1296-1305
• 12 Group KDIGOTW . KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 2009; 9 (Suppl 3) S1-S155
• 13 Harriss DJ, Macsween A, Atkinson G. Standards for ethics in sport and exercise science research: 2018 Update. Int J Sports Med 2017; 38: 1126-1131
• 14 Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, Hobbs FDR. Global prevalence of chronic kidney disease–a systematic review and meta-analysis. PLoS One 2016; 11: e0158765
• 15 KDIGO. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group . KDIGO 2012 Clinical Practice Guideline for the Evaluation and management of chronic kidney disease. Kidney Int Suppl 2013; 3: 1-150
• 16 Kdoqi . KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. Am J Kidney Dis 2007; 49: S12-S154
• 17 Kohl Lde M, Signori LU, Ribeiro RA, Silva AM, Moreira PR, Dipp T, Sbruzzi G, Lukrafka JL, Plentz RD. Prognostic value of the six-minute walk test in end-stage renal disease life expectancy: A prospective cohort study. Clinics 2012; 67: 581-586
• 18 Konstantinidou E, Koukouvou G, Kouidi E, Deligiannis A, Tourkantonis A. Exercise training in patients with end-stage renal disease on hemodialysis: Comparison of three rehabilitation programs. J Rehabil Med 2002; 34: 40-45
• 19 Kouidi EJ. Central and peripheral adaptations to physical training in patients with end-stage renal disease. Sports Med 2001; 31: 651-665
• 20 Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006; 145: 247-254
• 21 Meier-Kriesche H-U, Kaplan B. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: A Paired Donor Kidney Analysis1. Transplantation 2002; 74: 1377-1381
• 22 Moe SM, O’Neill KD, Resterova M, Fineberg N, Persohn S, Meyer CA. Natural history of vascular calcification in dialysis and transplant patients. Nephrol Dial Transplant 2004; 19: 2387-2393
• 23 Moraes Dias CJ, Anaisse Azoubel LM, Araújo Costa H, Costa Maia E, Rodrigues B, Silva-Filho AC, Dias-Filho CAA, Claúdia Irigoyen M, Leite RD, de Oliveira Junior MS, Mostarda CT. Autonomic modulation analysis in active and sedentary kidney transplanted recipients. Clin Exp Pharmacol Physiol 2015; 42: 1239-1244
• 24 Ouzouni S, Kouidi E, Sioulis A, Grekas D, Deligiannis A. Effects of intradialytic exercise training on health-related quality of life indices in haemodialysis patients. Clin Rehabil 2009; 23: 53-63
• 25 Petersen AC, Leikis MJ, McMahon LP, Kent AB, Murphy KT, Gong X, McKenna MJ. Impaired exercise performance and muscle Na(+), K(+)-pump activity in renal transplantation and haemodialysis patients. Nephrol Dial Transplant 2012; 27: 2036-2043
• 26 Petraki M, Kouidi E, Grekas D, Deligiannis a. Effects of exercise training during hemodialysis on cardiac baroreflex sensitivity. Clin Nephrol 2008; 70: 210-219
• 27 La Rovere MT, Pinna GD, Maestri R, Mortara A, Capomolla S, Febo O, Ferrari R, Franchini M, Gnemmi M, Opasich C, Riccardi PG, Traversi E, Cobelli F. Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients. Circulation 2003; 107: 565-570
• 28 Salman IM. Cardiovascular autonomic dysfunction in chronic kidney disease: a comprehensive review. Curr Hypertens Rep 2015; 17: 1-20
• 29 Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, McCullough PA, Kasiske BL, Kelepouris E, Klag MJ. Kidney disease as a risk factor for development of cardiovascular disease. Circulation 2003; 108: 2154-2169
• 30 Stack AG, Molony DA, Rives T, Tyson J, Murthy BVR. Association of physical activity with mortality in the US dialysis population. Am J Kidney Dis 2005; 45: 690-701
• 31 STROBE statement – Checklist of items that should be included in reports of observational studies (© STROBE Initiative). Int J Public Health 2008; 53: 3-4