Study finds ‘concerning’ lack of trials on exercise in early stages of kidney disease
Click Here to Manage Email Alerts
A study review showed exercise has a beneficial impact on patients with varying stages of kidney disease but, because most of the studies focused on those already on dialysis, the researchers urge physical activity be considered earlier.
According to Franklin C. Barcellos, MD, PhD, of the University of Pelotas in Brazil, and colleagues, while physical activity is recognized as critical in preventing many chronic diseases, clinicians seem to prescribe exercise less commonly for patients with kidney disease.
“This is noteworthy, considering that physical activity levels among [chronic kidney disease] CKD patients are significantly lower than among healthy individuals,” the researchers wrote. “Moreover, low aerobic capacity, a physical fitness marker that can be improved by exercise, has been pointed to as the strongest predictor of mortality among [end-stage renal disease] ESRD patients. Assuming that the benefits of exercise could also apply to CKD patients, physical activity deserves to be considered as a major component of treatment in all stages of the disease.”
To investigate the currently available evidence on the matter, Barcellos and colleagues reviewed 59 randomized clinical trials and found most lasted from 8 to 24 weeks, included small sample sizes and had a high risk of bias. In addition, most trials focused on patients already on hemodialysis, with three that looked at kidney transplant recipients and nine that considered patients “pre-dialysis.”
The researchers determined the studies supported the positive effects of exercise – most significantly of aerobic exercise – on patients with end-stage kidney disease, with improvements seen in physical fitness, muscular strength and quality of life. However, they noted there remains a lack of evidence regarding the impact of exercise in earlier stages of CKD due to the “scarcity” of trials on this specific population.
“From a public health standpoint, the fact that most studies included only hemodialysis patients represents a point of concern, because patients as well as health systems would most benefit from primary prevention or from interventions that increase survival and/or delay the need for [renal replacement therapy] RRT in earlier stages of CKD, whose population is [about] 20 times greater than the ESRD population,” Barcellos and colleagues wrote, adding that findings from the few observational studies that looked at patients with CKD stages 2 to 3 showed higher physical activity rates were associated with slower eGFR decline and greater likelihood of survival.
“If could be confirmed that exercise interventions are effective in delaying CKD progression and/or decrease mortality, the potential impact of such interventions for public health would be enormous,” they concluded.
Collapse
Read more about
Click Here to Manage Email Alerts