Aerobic Exercise in Patients With CKD
Condition: Chronic Kidney Diseases
MeSH terms: Kidney Diseases; Renal Insufficiency, Chronic
Study type: Interventional

Summary: 
      Patients with chronic kidney disease (CKD), especially those who are on dialysis, have a high
      prevalence of cardiovascular mortality and among the risk factors; inflammation and oxidative
      stress stand out. Furthermore, recently this scenario, beyond those alterations found in
      these patients, it has been suggested that the imbalance gut microbiota might be a new factor
      of cardiovascular risk. Some treatment strategies have been studied in order to modulate the
      gut microbiota and inflammation, such as the implementation of exercise programs. However,
      the effects of exercise on the modulation of the gut microflora and inflammation have not
      been evaluated in these patients. The aim of this project is to investigate possible changes
      in gut microbiota, levels of uremic toxins and inflammatory and cardiovascular markers in CKD
      patients on hemodialysis, after application of a training program with aerobic exercise.
    

Detailed description: 
      Chronic kidney disease (CKD) patients on hemodialysis (HD) patients present reduced
      functional capacity to approximately 50% and uremic myopathy and disuse atrophy have a
      significant impact on the functional capacity of these patients (Johansen, 1999; Parsons,
      2006).

      There are several physical exercise benefits for CKD patients, such as improved ability to
      perform exercises, increase of strength, quality of life and improve the maximal oxygen
      consumption (VO2MÁX), which contributes to the improvement of cardiovascular aspects
      (Johansen, 2007; Johansen, 2005; Heiwe, 2014). In fact, CKD patients who practice regular
      exercise have a higher survival rate (O'Hare et al., 2003).

      In addition, some mechanisms regarding anti-inflammatory effects of the exercises has been
      proposed, such as: reduction of visceral fat which decreases the secretion of
      pro-inflammatory cytokines, increased production and release of anti-inflammatory cytokines
      from muscle contraction and reduced expression of Toll-like receptors (TLRs) in monocytes and
      macrophages, which decreases the pro-inflammatory response (Petersen & Pedersen, 2005;
      Gleeson et al., 2006).

      In parallel, during exercises like running or cycling, there is an increase in capillary
      surface area, with opening of capillaries previously inactive, consequently increasing
      exchange of substances between the blood and the tissues. Thus, physical exercise could
      result in a greater flux of urea and associated toxins from tissue to vascular compartment,
      improving the efficiency of dialysis (Parsons et al., 2006; Guyton E Hall, 2017). According
      KDOQI (Kidney Disease Outcomes Quality Initiative), Kt/V, a measure of urea clearance, is the
      most frequently applied measure of the delivered dialysis dose and reflects the dialyzer
      effect on patient survival (KDOQI, 2015).

      Despite results showing the benefits of exercise to CKD patients, they are poorly prescribed,
      remaining a challenge in clinical practice and high rates of physical inactivity are observed
      in these patients (Williams et al., 2014; Barcellos, 2018).

      Some gaps still need to be filled regarding the not yet known effect of physical exercise on
      a number of clinical factors, thus allowing more specific and objective recommendations
      (Williams et al., 2014). In this context, the present study aims to verify the effects of
      12-week supervised and individualized intradialytic bicycle ergometer exercise on the
      adequacy of dialysis, inflammatory markers and functional capacity of HD patients.
    

Intervention name(s): Aerobic exercise
Intervention type(s): Other
Intervention description(s): Intradialytic aerobic exercise
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Treatment