Aim: This study aimed to examine the effects of exercise training on kidney function and nutrition status in obese Chronic Kidney Disease (CKD) patients. Methods: This is a prospective randomized controlled trial. Twelve adult obese CKD patients were randomly assigned to dietary instruction alone group (Group-D) or to both dietary instruction and exercise training group (Group-E). All patients received supervised dietary advice including calorie, protein, and salt intake for a period of 12 weeks. In addition, patients in Group-E underwent a fitness-training program. A change in glomerular filtration rate (GFR) was the main outcome. Secondary outcomes were changes in body mass index, serum creatinine-based estimated-GFR, serum albumin, and albuminuria. Results: Changes in GFR and all secondary outcomes were not statistically significant in either of the two groups. Although exercise training did not appear to significantly affect serum albumin levels in either group, it did present with a large sized effect. Conclusion: Exercise training might not have any effect on kidney function; however, the combination of exercise training along with dietary advice may prove to be more effective in maintaining the nutrition status when compared with dietary instructions alone in obese CKD patients. These results suggest that appropriate exercise training with dietary instructions is recommended for the treatment of obese CKD patients.
References
[1]
Go, A.S., Chertow, G.M., Fan, D., McCulloch, C.E. and Hsu, C.Y. (2004) Chronic Kidney Disease and the Risks of Death, Cardiovascular Events, and Hospitalization. New England Journal of Medicine, 351, 1296-1305. http://dx.doi.org/10.1056/NEJMoa041031
[2]
Keith, D.S., Nichols, G.A., Gullion, C.M., Brown, J.B. and Smith, D.H. (2004) Longitudinal Follow-Up and Outcomes among a Population with Chronic Kidney Disease in a Large Managed Care Organization. Archives of Internal Medicine, 164, 659-663. http://dx.doi.org/10.1001/archinte.164.6.659
[3]
Nakai, S., Watanabe, Y., Masakane, I., Wada, A., Shoji, T., Hasegawa, T., Nakamoto, H., Yamagata, K., Kazama, J.J., Fujii, N., Itami, N., Shinoda, T., Shigematsu, T., Marubayashi, S., Morita, O., Hashimoto, S., Suzuki, K., Kimata, N., Hanafusa, N., Wakai, K., Hamano, T., Ogata, S., Tsuchida, K., Taniguchi, M., Nishi, H., Iseki, K. and Tsubakihara. Y. (2013) Overview of Regular Dialysis Treatment in Japan (as of 31 December 2011). Therapeutic Apheresis and Dialysis, 17, 567-611. http://dx.doi.org/10.1111/1744-9987.12147
[4]
Yamagata, K., Ishida, K., Sairenchi, T., Takahashi, H., Ohba, S., Shiigai, T., Narita, M. and Koyama, A. (2007) Risk Factors for Chronic Kidney Disease in a Community-Based Population: A 10-Year Follow-Up Study. Kidney International, 71, 159-166. http://dx.doi.org/10.1038/sj.ki.5002017
[5]
Wakasugi, M., Narita, I., Iseki, K., Moriyama, T., Yamagata, K., Tsuruya, K., Yoshida, H., Fujimoto, S., Asahi, K., Kurahashi, I., Ohashi, Y. and Watanabe, T. (2012) Weight Gain after 20 Years of Age Is Associated with Prevalence of Chronic Kidney Disease. Clinical and Experimental Nephrology, 16, 259-268. http://dx.doi.org/10.1007/s10157-011-0565-3
[6]
Thomas, G., Sehgal, A.R., Kashyap, S.R., Srinivas, T.R., Kirwan, J.P. and Navaneethan, S.D. (2011) Metabolic Syndrome and Kidney Disease: A Systematic Review and Meta-Analysis. Clinical Journal of the American Society of Nephrology, 6, 2364-2373. http://dx.doi.org/10.2215/CJN.02180311
[7]
Alexander, M.P., Patel, T.V., Farag, Y.M., Florez, A., Rennke, H.G. and Singh, A.K. (2009) Kidney Pathological Changes in Metabolic Syndrome: A Cross-Sectional Study. American Journal of Kidney Diseases, 53, 751-759. http://dx.doi.org/10.1053/j.ajkd.2009.01.255
[8]
The Ministry of Health, Labour and Welfare of Japan (2010) National Health and Nutrition Survey. http://www.mhlw.go.jp/english/policy/health-medical/health/index.html
[9]
Iseki, K. (2005) Factors Influencing the Development of End-Stage Renal Disease. Clinical and Experimental Nephrology, 9, 5-14. http://dx.doi.org/10.1053/j.ajkd.2009.01.255
[10]
Pechter, U., Ots, M., Mesikepp, S., Zilmer, K., Kullissaar, T., Vihalemm, T., Zilmer, M. and Maaroos, J. (2003) Beneficial Effects of Water-Based Exercise in Patients with Chronic Kidney Disease. International Journal of Rehabilitation Research, 26, 153-156. http://dx.doi.org/10.1097/00004356-200306000-00013
[11]
Toyama, K., Sugiyama, S., Oka, H., Sumida, H. and Ogawa, H. (2010) Exercise Therapy Correlates with Improving Renal Function through Modifying Lipid Metabolism in Patients with Cardiovascular Disease and Chronic Kidney Disease. Journal of Cardiology, 56, 142-146. http://dx.doi.org/10.1016/j.jjcc.2010.06.007
[12]
Johansen, K.L. and Painter, P. (2012) Exercise in Individuals with CKD. American Journal of Kidney Diseases, 59, 126-134. http://dx.doi.org/10.1053/j.ajkd.2011.10.008
[13]
Levey, A.S., de Jong, P.E., Coresh, J., El Nahas, M., Astor, B.C., Matsushita, K., Gansevoort, R.T., Kasiske, B.L. and Eckardt, K.U. (2011) The Definition, Classification, and Prognosis of Chronic Kidney Disease: A KDIGO Controversies Conference Report. Kidney International, 80, 17-28. http://dx.doi.org/10.1038/ki.2010.483
[14]
Hemmelgarn, B.R., Zhang, J., Manns, B.J., Tonelli, M., Larsen, E., Ghali, W.A., Southern, D.A., McLaughlin, K., Mortis, G. and Culleton, B.F. (2006) Progression of Kidney Dysfunction in the Community-Dwelling Elderly. Kidney International, 69, 2155-2161. http://dx.doi.org/10.1038/sj.ki.5000270
[15]
Iseki, K., Ikemiya, Y., Iseki, C. and Takishita, S. (2003) Proteinuria and the Risk of Developing End-Stage Renal Disease. Kidney International, 63, 1468-1474. http://dx.doi.org/10.1046/j.1523-1755.2003.00868.x
[16]
Leehey, D.J., Moinuddin, I., Bast, J.P., Qureshi, S., Jelinek, C.S., Cooper, C., Edwards, L.C., Smith, B.M. and Collins, E.G. (2009) Aerobic Exercise in Obese Diabetic Patients with Chronic Kidney Disease: A Randomized and Controlled Pilot Study. Cardiovascular Diabetology, 8, 62. http://dx.doi.org/10.1186/1475-2840-8-62
[17]
Yamamoto-Kabasawa, K., Hosojima, M., Yata, Y., Saito, M., Tanaka, N., Tanaka, J., Tanabe, N., Narita, I., Arakawa, M. and Saito, A. (2015) Benefits of a 12-Week Lifestyle Modification Program Including Diet and Combined Aerobic and Resistance Exercise on Albuminuria in Diabetic and Non-Diabetic Japanese Populations. Clinical and Experimental Nephrology, 19, 1079-1089. http://dx.doi.org/10.1007/s10157-015-1103-5
[18]
Leube, V. (1878) Quoted in Albuminuria in Health. The Lancet, 1, 503.
[19]
CKD Guideline Editorial Committee (2009) Evidence-Based Practice Guideline for the Treatment of CKD. Nihon Jinzo Gakkai Shi, 51, 905-1066.
[20]
The Ministry of Education, Culture, Sports, Science and Technology of Japan (2010) Standard Tables of Food Composition in Japan. http://www.mext.go.jp/english/science_technology/1347490.htm
[21]
Gore, C.J., Booth, M.L., Bauman, A. and Owen, N. (1999) Utility of Pwc75% as an Estimate of Aerobic Power in Epidemiological and Population-Based Studies. Medicine & Science in Sports & Exercise, 31, 348-351. http://dx.doi.org/10.1097/00005768-199902000-00020
[22]
Pietilainen, K.H., Kaye, S., Karmi, A., Suojanen, L., Rissanen, A. and Virtanen, K.A. (2013) Agreement of Bioelectrical Impedance with Dual-Energy X-Ray Absorptiometry and MRI to Estimate Changes in Body Fat, Skeletal Muscle and Visceral Fat during a 12-Month Weight Loss Intervention. British Journal of Nutrition, 109, 1910-1916. http://dx.doi.org/10.1017/S0007114512003698
[23]
Matsuo, S., Imai, E., Horio, M., Yasuda, Y., Tomita, K., Nitta, K., Yamagata, K., Tomino, Y., Yokoyama, H. and Hishida, A. (2009) Revised Equations for Estimated GFR from Serum Creatinine in Japan. American Journal of Kidney Diseases, 53, 982-992. http://dx.doi.org/10.1053/j.ajkd.2008.12.034
[24]
Nakano, H. and Inoue, S. (2010) Quantity of Physical Exercise Expended during Commuting by Office Workers Residing in the Greater Tokyo Area. Sangyo Eiseigaku Zasshi, 52, 133-139. http://dx.doi.org/10.1539/sangyoeisei.B9018
[25]
Ainsworth, B.E., Haskell, W.L., Whitt, M.C., Irwin, M.L., Swartz, A.M., Strath, S.J., O’Brien, W.L., Bassett Jr., D.R., Schmitz, K.H., Emplaincourt, P.O., Jacobs Jr., D.R. and Leon, A.S. (2000) Compendium of Physical Activities: An Update of Activity Codes and MET Intensities. Medicine & Science in Sports & Exercise, 32, S498-S504. http://dx.doi.org/10.1097/00005768-200009001-00009
[26]
Nakagawa, S. and Cuthill, I.C. (2007) Effect Size, Confidence Interval and Statistical Significance: A Practical Guide for Biologists. Biological Reviews of the Cambridge Philosophical Society, 82, 591-605. http://dx.doi.org/10.1111/j.1469-185X.2007.00027.x
[27]
Faul, F., Erdfelder, E., Lang, A.G. and Buchner, A. (2007) G*Power 3: A Flexible Statistical Power Analysis Program for the Social, Behavioral, and Biomedical Sciences. Behavior Research Methods, 39, 175-191. http://dx.doi.org/10.3758/BF03193146
[28]
Eidemak, I., Haaber, A.B., Feldt-Rasmussen, B., Kanstrup, I.L. and Strandgaard, S. (1997) Exercise Training and the Progression of Chronic Renal Failure. Nephron, 75, 36-40. http://search.proquest.com/docview/274360200?accountid=25225 http://dx.doi.org/10.1159/000189497
[29]
Slee, A.D. (2012) Exploring Metabolic Dysfunction in Chronic Kidney Disease. Nutrition & Metabolism, 9, 36. http://dx.doi.org/10.1186/1743-7075-9-36
[30]
Suga, Y., Tanabe, K., Kim, J., Sato, H., Iwashita, S., Hamada, K. and Kuno, S. (2013) A Comparison of the Influences of Soyvs. Wheat-Based Supplements on Weight Loss in Middle-Aged Subjects. International Journal of Sport and Health Science, 11, 10-19. http://dx.doi.org/10.5432/ijshs.201201
[31]
Ross, R., Dagnone, D., Jones, P.J., Smith, H., Paddags, A., Hudson, R. and Janssen, I. (2000) Reduction in Obesity and Related Comorbid Conditions after Diet-Induced Weight Loss or Exercise-Induced Weight Loss in Men: A Randomized, Controlled Trial. Annals of Internal Medicine, 133, 92-103. http://dx.doi.org/10.7326/0003-4819-133-2-200007180-00008
[32]
Redman, L.M., Heilbronn, L.K., Martin, C.K., Alfonso, A., Smith, S.R. and Ravussin, E. (2007) Effect of Calorie Restriction with or without Exercise on Body Composition and Fat Distribution. The Journal of Clinical Endocrinology & Metabolism, 92, 865-872. http://dx.doi.org/10.1210/jc.2006-2184
