• Sharlene A Greenwood, Pelagia Koufaki, Thomas H Mercer, Helen L MacLaughlin, Robert Rush, Herolin Lindup, Ellen O'Connor, Christopher Jones, Bruce M Hendry, Iain C Macdougall, and Hugh S Cairns.
• Department of Renal Medicine, King's College Hospital, London, United Kingdom; Renal Medicine, King's College Hospital, London, United Kingdom. Electronic address: sharlene.greenwood@nhs.net.
• Am. J. Kidney Dis. 2015 Mar 1; 65 (3): 425-34.

BackgroundExercise capacity, which is predictive of all-cause mortality and cardiovascular disease risk, is reduced significantly in patients with non-dialysis-dependent chronic kidney disease. This pilot study examined the effect of moderate-intensity exercise training on kidney function and indexes of cardiovascular risk in patients with progressive chronic kidney disease stages 3 to 4.Study DesignSingle-blind, randomized, controlled, parallel trial.Setting & Participants20 patients (aged 18-80 years; 17 men) randomly assigned to rehabilitation (n=10) or usual care (n=10). Participants were included if they were 18 years or older and had evidence of rate of decline in creatinine-based estimated glomerular filtration rate (eGFRcr)≥2.9mL/min/1.73m(2) per year for 12 months preintervention. Patients were excluded if they had unstable medical conditions or had recently started regular exercise.InterventionThe rehabilitation group received resistance and aerobic training (3 days per week) for a 12-month period. The usual care group received standard care.OutcomesKidney function assessed by comparing mean rate of change in eGFRcr (mL/min/1.73m(2) per year) from a 12-month preintervention period against the 12-month intervention period. Pulse wave velocity (PWV), peak oxygen uptake (Vo2peak), and waist circumference assessed at 0, 6, and 12 months.MeasurementseGFR assessed using creatinine, cystatin C (eGFRcys), and a combination of both values (eGFRcr-cys).Results18 participants (rehabilitation, 8; usual care, 10) completed the study. A significant mean difference in rate of change in eGFRcr (+7.8±3.0 [95% CI, 1.1-13.5] mL/min/1.73m(2) per year; P=0.02) was observed between the rehabilitation and usual care groups, with the rehabilitation group demonstrating a slower decline. No significant between-group mean differences existed in absolute eGFRcr, eGFRcr-cys, or eGFRcys at 12 months of study intervention. Significant between-group mean differences existed in PWV (-2.30 [95% CI, -3.02 to -1.59] m/s), waist circumference (-7.1±12.8 [95% CI, -12.4 to -3.2] cm), and Vo2peak (5.7 [95% CI, 1.34-10.10] mL/kg/min). Change in eGFRcr was correlated inversely with PWV (r=-0.5; P=0.04) at 12 months.LimitationsSmall sample size, inconsistency between primary and secondary measures of kidney function.ConclusionsThe effect of a 1-year exercise intervention on progression of kidney disease is inconclusive. A larger study with longer follow-up may be necessary.Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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