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J Am Soc Nephrol. 2018 Jan;29(1):250-259. doi: 10.1681/ASN.2017010020. Epub 2017 Oct 16.

Metabolic Effects of Diet and Exercise in Patients with Moderate to Severe CKD: A Randomized Clinical Trial.

Author information

1
Division of Nephrology, Department of Medicine.
2
Vanderbilt Center for Kidney Disease, and.
3
Department of Exercise Science and Sport Studies, Springfield College, Springfield, Massachusetts.
4
Kidney Research Institute and.
5
Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington.
6
Providence Medical Research Center, Providence Health Care, Spokane, Washington.
7
University of Massachusetts School of Medicine, Baystate Medical Center, Springfield, Massachusetts; and.
8
Department of Medicine, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Pakkret, Thailand.
9
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.

Abstract

CKD is steadily increasing along with obesity worldwide. Furthermore, obesity is a proinflammatory risk factor for progression of CKD and cardiovascular disease. We tested the hypothesis that implementation of caloric restriction and aerobic exercise is feasible and can improve the proinflammatory metabolic milieu in patients with moderate to severe CKD through a pilot, randomized, 2×2 factorial design trial. Of 122 participants consented, 111 were randomized to receive caloric restriction and aerobic exercise, caloric restriction alone, aerobic exercise alone, or usual care. Of those randomized, 42% were women, 25% were diabetic, and 91% were hypertensive; 104 started intervention, and 92 completed the 4-month study. Primary outcomes were a change from baseline in absolute fat mass, body weight, plasma F2-isoprostane concentrations, and peak oxygen uptake (VO2 peak). Compared with usual care, the combined intervention led to statistically significant decreases in body weight and body fat percentage. Caloric restriction alone also led to significant decreases in these measures, but aerobic exercise alone did not. The combined intervention and each independent intervention also led to significant decreases in F2-isoprostane and IL-6 concentrations. No intervention produced significant changes in VO2 peak, kidney function, or urine albumin-to-creatinine ratio. In conclusion, 4-month dietary calorie restriction and aerobic exercise had significant, albeit clinically modest, benefits on body weight, fat mass, and markers of oxidative stress and inflammatory response in patients with moderate to severe CKD. These results suggest healthy lifestyle interventions as a nonpharmacologic strategy to improve markers of metabolic health in these patients.

KEYWORDS:

Chronic inflammation; chronic kidney disease; diet; exercise; metabolism; oxidative stress

PMID:
29038285
PMCID:
PMC5748901
DOI:
10.1681/ASN.2017010020
[Indexed for MEDLINE]
Free PMC Article

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