Home-based versus center-based aerobic exercise on cardiopulmonary performance,physical function,quality of life and quality of sleep of overweight patients with chronic kidney disease

Background

The association between chronic kidney disease (CKD) and obesity can decrease the patients’ cardiopulmonary capacity, physical functioning and quality of life. The search for effective and practical alternative methods of exercise to engage patients in training programs is of great importance. Therefore, we aimed to compare the effects of home-based versus center-based aerobic exercise on the cardiopulmonary and functional capacities, quality of life and quality of sleep of overweight non-dialysis-dependent patients with CKD (NDD-CKD).

Methods

Forty sedentary overweight patients CKD stages 3 and 4 were randomly assigned to an exercise group [home-based group (n = 12) or center-based exercise group (n = 13)] or to a control group (n = 15) that did not perform any exercise. Cardiopulmonary exercise test, functional capacity tests, quality of life, quality of sleep and clinical parameters were assessed at baseline, 12 and 24 weeks.

Results

The VO_2peak and all cardiopulmonary parameters evaluated were similarly improved (p < 0.05) after 12 and 24 weeks in both exercise groups. The functional capacity tests improved during the follow-up in the home-based group (p < 0.05) and reached values similar to those obtained in the center-based group. The benefits achieved in both exercise groups were also reflected in improvement of quality of life and sleep (p < 0.05). No differences were observed between the exercise groups, and no changes in any of the parameters investigated were found in the control group.

Conclusion

Home-based aerobic training was as effective as center-based training in improving the physical and functional capabilities, quality of life and sleep in overweight NDD-CKD patients.

     

Prognostic impact of galectin-3 in chronic kidney disease patients: a systematic review and meta-analysis

International Urology and Nephrology - Galectin-3 as a β-galactoside-binding lectin, which has served important functions in numerous biological activities including cell growth, apoptosis,...     

Effects of exercise training on physical impairment,arterial stiffness and health-related quality of life in patients with chronic kidney disease: a pilot study

Background  

Patients with chronic kidney disease (CKD) have impaired performance in physical tasks, lower health-related quality of life and high cardiovascular morbidity and mortality. Moderate intensity exercise has been shown to provide cardiovascular and metabolic benefits in healthy individuals and patients without CKD. Long-term exercise training is recommended as a vital component in the management of a number of chronic diseases. This randomized controlled pilot project examined the effects of exercise in predialysis CKD patients.     

A systematic review of trials investigating the efficacy of exercise training for functional capacity and quality of life in chronic kidney disease patients

International Urology and Nephrology - To investigate the efficacy of exercise training on functional capacity and quality of life in chronic kidney disease. SCOPUS, CINAHL, Science Direct, Web of...     

Efficacy of statins on renal function in patients with chronic kidney disease: a systematic review and meta-analysis

BackgroundStudies have shown that the use of statins could significantly improve lipid profiles; however, it remains controversial whether the use of statins could improve renal function in patients with chronic kidney disease (CKD). Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the effects of statins on renal function in patients with CKD.MethodsWe systematically searched PubMed, EMBASE, and the Cochrane Library databases for eligible RCTs from inception to October 2020. Pooled effect estimates were assigned as weighted mean differences (WMDs) with 95% confidence intervals (CIs) using the random-effects model.ResultsWe selected 33 RCTs that recruited 37,391 patients with CKD patients. The summary results suggested that statin use significantly reduced urinary albumin (WMD: −2.04; 95%CI: −3.53 to −0.56; p = .007) and protein (WMD: −0.58; 95%CI: −0.95 to −0.21; p = .002) excretions and increased creatinine clearance (WMD: 0.86; 95%CI: 0.32–1.41; p = .002). However, there were no significant differences between statin and control groups in terms of changes in estimated glomerular filtration rate (WMD: 0.38; 95%CI: −0.04 to 0.79; p = .075), and serum creatinine levels (WMD: −0.07; 95%CI: −0.25, 0.12; p = .475).ConclusionsWe found that statin use in patients with CKD may slow CKD progression by lowering urinary albumin and protein excretions or increasing creatinine clearance. Further large-scale RCTs should be conducted to evaluate the long-term effects of statins on renal outcomes. Abbreviations: CKD: chronic kidney disease; RCT: randomized controlled trials; WMD: weighted mean differences; CI: confidence intervals; ACEI: angiotensin-converting enzyme inhibitors; eGFR: estimated glomerular filtration rate     

Evaluation of quality of life,physical, and mental aspects in longevous patients with chronic kidney disease

Purpose

The diagnosis of chronic kidney disease (CKD) in elderly individuals has been increasing. The objective of this study was to evaluate physical, mental and social aspects in longevous elderly patients with CKD.

Methods

Eighty patients with CKD (stage 4 and 5, not on dialysis) and 60 longevous elderly (≥ 80 years) paired by gender and age living in the community were evaluated. Physical, cognitive, social and quality of life aspects were analyzed according to the following scales: Charlson comorbidity index, Medical Outcomes Study Short Form 36-Item (SF-36), Medical Outcomes Study, Boston Naming Test, verbal fluency test (animal naming), sit-to-stand test, gait speed, and the Mini-Mental state examination.

Results

Compared to the control group, the CKD group had a higher mean in the comorbidities index (3.5 ± 1.2 vs. 1.0 ± 1, respectively, p < 0.001). In the multivariate analysis, the CKD group presented worse performance in the SF-36 dimensions: ‘physical functioning,’ ‘general health,’ ‘emotional functioning,’ ‘vitality,’ and physical component summary. On the other hand, they presented better results for the ‘mental health’ dimension, in addition to lower  social support, worse verbal fluency and worse results on the sit-to-stand test.

Conclusions

Longevous patients with stage 4 or 5 CKD presented worse evaluation in several domains of physical and emotional functioning, lower social support and evidence of worse cognitive performance. These aspects should be taken into account in order to improve the care provided to these patients, improve their quality of life and prevent their morbidity.

     

The impact of HIV on chronic kidney disease outcomes

Chronic kidney disease (CKD) is a known complication of the human immunodeficiency virus (HIV) but outcomes among HIV-infected patients with kidney disease are unknown. We studied a national sample of 202,927 patients with CKD (stage 3 or higher) for death, end-stage renal disease (ESRD) and the mean annual rate of decline in estimated glomerular filtration rate (eGFR) over a median period of 3.8 years. Within this sample, 0.3% of the patients were diagnosed with HIV, 43.5% were diabetic, whereas the remainder had neither disease. In this national CKD cohort, HIV-infected black patients were at higher risk of death, a similar risk for ESRD and loss of eGFR than black patients with diabetes. HIV-infected white patients experienced higher rates of death but a lower risk of ESRD than their counterparts with diabetes. Our results highlight a need to study mortality and mechanisms of ESRD in the HIV infected population.     

Effects of aspirin on cardiovascular outcomes in patients with chronic kidney disease

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Effects of oral alkali drug therapy on clinical outcomes in pre-dialysis chronic kidney disease patients: a systematic review and meta-analysis

BackgroundMetabolic acidosis accelerates the progression of chronic kidney disease (CKD) and increases the mortality rate. Whether oral alkali drug therapy benefits pre-dialysis CKD patients is controversial. We performed a meta-analysis of the effects of oral alkali drug therapy on major clinical outcomes in pre-dialysis CKD patients.MethodsWe systematically searched MEDLINE using the Ovid, EMBASE, and Cochrane Library databases without language restriction. We included all eligible clinical studies that involved pre-dialysis CKD adults and compared those who received oral alkali drug therapy with controls.ResultsA total of 18 eligible studies, including 14 randomized controlled trials and 4 cohort studies reported in 19 publications with 3695 participants, were included. Oral alkali drug therapy led to a 55% reduction in renal failure events (relative risk [RR]: 0.45; 95% confidence interval [CI]: 0.25–0.82), a rate of decline in the estimated glomerular filtration rate (eGFR) of 2.59 mL/min/1.73 m² per year (95% CI, 0.88–4.31). There was no significant effect on decline in eGFR events (RR: 0.34; 95% CI: 0.09–1.23), proteinuria (standardized mean difference: −0.32; 95% CI: −1.08 to 0.43), all-cause mortality events (RR: 0.90; 95% CI: 0.40–2.02) and cardiovascular (CV) events (RR: 1.03; 95% CI: 0.32–3.37) compared with the control groups.ConclusionBased on the available and low-to-moderate certainty evidence, oral alkali drug therapy might potentially reduce the risk of kidney failure events, but no benefit in reducing all-cause mortality events, CV events, decline in eGFR and porteninuria.     

Insight into the impact of vitamin D on cardiovascular outcomes in chronic kidney disease

Patients with chronic kidney disease (CKD) experience excess cardiovascular morbidity and mortality that is unexplained by traditional cardiovascular risk factors. Vitamin D deficiency is highly prevalent in CKD and is associated with increased cardiovascular mortality in both the general population and in CKD patients. Vitamin D supplementation is a reasonably safe and simple intervention and meta‐analyses of observational studies have suggested that vitamin D supplementation in CKD improves cardiovascular mortality. However, randomized controlled trials examining the impact of vitamin D supplementation in improving surrogate markers of cardiovascular structure and function remain inconclusive. This review investigates the impact of vitamin D supplementation on surrogate end‐points and cardiovascular events from trials in CKD; and discusses why results have been heterogenous, particularly critiquing the effect of different dosing regimens and the failure to take into account the implications of vitamin D supplementation in study participants with differing vitamin D binding protein genotypes.     

The effects of physical self-management on quality of life in breast cancer patients: A systematic review

The aim of this systematic review is to report on the effects of different physical self-management techniques on quality of life (QoL) of patients with breast cancer. Therefore a systematic literature search was performed using four different databases (PubMed, Cochrane, Embase, Web of science). The inclusion criteria were: 1) adults >18 y, 2) patients with breast cancer, 3) physical self-management techniques during or after initial treatment, 4) outcome measure needed to be an indicator of patients' quality of life 5), Randomized Controlled Trials of all ages. The methodological quality of the selected articles was assessed. The results concerning quality of life outcomes were extracted. A total of 13 RCT's, representing 2180 participants were included. Different self-management techniques were identified such as a booklet, brochure, multimedia and recommendations. Disregarding the type of intervention, most studies found a positive effect of physical activity on QoL outcomes such as fatigue, physical functioning, emotional and/or social wellbeing. The results of the interventions during or after primary treatment of breast cancer are discussed separately. Studies that started their intervention during primary treatment found an improvement in QoL or a slower decrease in QoL. Studies that started the intervention after primary treatment found an increase in QoL. In conclusion, physical self-management interventions during breast cancer treatment as well as after the primary treatment seem to generate beneficial effects on QoL.     

Effects of exercise on markers of inflammation and indicators of nutrition in patients with chronic kidney disease: a systematic review and meta-analysis

International Urology and Nephrology - This meta-analysis aimed to reveal the effects of exercise training on markers of inflammation and indicators of nutrition in non-dialysis-dependent patients...     

Mortality in chronic kidney disease patients with COVID-19: a systematic review and meta-analysis

International Urology and Nephrology - At the beginning of 2020, the outbreak of coronavirus disease 2019 (COVID-19) led to a worldwide pandemic and mass panic. The number of infected people has...     

Decreased physical function in pre-dialysis patients with chronic kidney disease

Background

Patients undergoing dialysis experience decreases in physical function; however, few data exist on physical function in pre-dialysis patients with chronic kidney disease (CKD). The primary objective of this study was to clarify physical function in pre-dialysis patients according to CKD stage.

Methods

This was a cross-sectional study of 120 ambulant pre-dialysis CKD stage 2 or higher patients (85 male, 35 female; mean age 66.5 years) who visited St. Marianna University School of Medicine Hospital. Participants were grouped according to CKD stage as follows: stage 2 (n = 17), stage 3 (n = 55), stage 4 (n = 25), and stage 5 (n = 23). Handgrip strength, knee extensor muscle strength, single-leg stance time, and maximum gait speed were used to assess physical function. Clinical laboratory tests were also examined at the same time as physical function measurements.

Results

All indices of physical function decreased according to the progression of CKD. Each physical function index was significantly lower in CKD stage 4 or 5 patients than CKD stage 2 or 3 patients. All physical function indices showed a positive correlation with estimated glomerular filtration rate (eGFR), blood hemoglobin level, and serum albumin level, and a negative correlation with urinary protein levels. In multiple regression analysis, age, female sex, body mass index, eGFR and urinary protein were significantly correlated with indices of physical function.

Conclusion

Physical function in pre-dialysis CKD patients decreased as the disease progressed according to stage. Early intervention in CKD patients might delay the loss of physical function.     

慢性肾脏病患者生活质量对肾功能进展的影响

目的 了解慢性肾脏病(chronic kidney disease,CKD)2～4期未透析患者生活质量状况,并探讨其对肾功能进展的影响.方法 对湖北省中医院肾病科门诊的138例CKD 2～4期患者规律随访2年并定期进行生活质量评估及血肌酐测量,同时记录性别、年龄、病程、原发病、血压、身高、体质量,计算体质量指数;比较CKD 2～4期患者生活质量差异.将138例患者根据肾功能进展情况分为肾功能进展组与肾功能无进展组,比较2组基本情况及生活质量差异,采用非条件Lo-gistic回归分析,分析肾功能进展的危险因素.结果 ①CKD 2～4期患者生活质量10个维度得分比较,CKD 4期组均较CKD 3期组、CKD 2期组低,且在症状影响、肾病影响、身体功能、社会功能、精力、体力方面差异有统计学意义(P＜0.05).②肾功能进展组与肾功能无进展组比较,肾功能进展组体质量指数低于肾功能无进展组,差异有统计学意义(P＜0.05);生活质量10个维度中,肾功能进展组得分低于肾功能无进展组,在症状影响、肾病影响、肾病负担、身体功能、情感状况、社会情感、精力、体力方面差异有统计学意义(P＜0.05).③肾功能进展危险因素分析,体质量指数、症状影响、身体功能、情感状况为肾功能进展的危险因素.结论 CKD患者的生活质量随着肾小球滤过率下降而降低,且肾功能进展者生活质量较差.生活质量中症状影响、身体功能及情感状况是肾功能进展的危险因素,提示CKD患者生活质量下降加速病情进展的恶性循环,关注其生活质量十分必要.     

The impact of inflammation on metabolic regulation in chronic kidney disease: a review.

Chronically uremic patients are characterized by a low-grade systemic inflammation that reflects the consequences of an unbalanced production of proinflammatory and anti-inflammatory cytokines and contributes to the progression of atherosclerotic vascular disease and malnutrition. The causes of inflammation in end-stage kidney disease have been studied in details. Nonetheless, the degree of activation of the systemic inflammatory response shows great interindividual variability that cannot be explained by renal disease or dialysis. The amount of cytokine that is produced on a definite stimulus varies among individuals. Single nucleotide polymorphisms in the promoter or coding regions of cytokine genes lead to high or low productions of these mediators and may genetically explain this heterogeneity. The "low-producer" genotypes for the anti-inflammatory cytokine interleukin-10 are more permissive for a greater level of systemic inflammation and for increased cardiovascular morbidity and mortality in patients on hemodialysis. Potential pharmacologic and nutritional approaches for treatment of systemic inflammation have been identified in recent years. In addition, physical exercise training may reduce the systemic inflammatory response. Definition of the relationships between different cytokine gene polymorphisms and systemic inflammation in chronically uremic patients will improve efficacy of targeted anti-inflammatory treatments.     

Prevalence of chronic kidney disease in Bangladesh: a systematic review and meta-analysis

International Urology and Nephrology - Worldwide, chronic kidney disease (CKD) is a major public health issue, with a leading cause of death and disability. The aim of our study to estimate the...     

Improvement of kidney function in patients with chronic kidney disease and severe obesity after bariatric surgery: A systematic review and meta-analysis

The general management for chronic kidney disease (CKD) includes treating reversible causes, including obesity, which may be both a driver and comorbidity for CKD. Bariatric surgery has been shown to reduce the likelihood of CKD progression and improve kidney function in observational studies. We performed a systematic review and meta-analysis of patients with at least stage 3 CKD and obesity receiving bariatric surgery. We searched Embase, MEDLINE, CENTRAL and identified eligible studies reporting on kidney function outcomes in included patients before and after bariatric surgery with comparison to a medical intervention control if available. Risk of bias was assessed with the Newcastle-Ottawa Risk of Bias score. Nineteen studies were included for synthesis. Bariatric surgery showed improved eGFR with a mean difference (MD) of 11.64 (95%CI: 5.84 to 17.45, I² = 66%) ml/min/1.73m² and reduced SCr with MD of ?0.24 (95%CI ?0.21 to ?0.39, I² = 0%) mg/dl after bariatric surgery. There was no significant difference in the relative risk (RR) of having CKD stage 3 after bariatric surgery, with a RR of ?1.13 (95%CI: ?0.83 to ?2.07, I² = 13%), but there was reduced likelihood of having uACR >30 mg/g or above with a RR of ?3.03 (95%CI: ?1.44 to ?6.40, I² = 91%). Bariatric surgery may be associated with improved kidney function with the reduction of BMI and may be a safe treatment option for patients with CKD. Future studies with more robust reporting are required to determine the feasibility of bariatric surgery for the treatment of CKD.