#119 Exercise intervention in patients with metabolic syndrome and renal disease: a prospective study (EXRED)

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Abstract Background and Aims In patients with chronic kidney disease (CKD) of diverse causes, obesity and metabolic syndrome (MS) accelerate disease progression. Therapeutic exercise could be effective in treating obesity and MS in patients with CKD. However, the evidence in this area is limited. The aim of this study was to evaluate the effect of an individualized exercise program on major metabolic and renal outcomes in patients with CKD, obesity and MS. Method This was an interventional, exploratory study that included patients with established CKD - estimated glomerular filtration rate (eGFR) ≥30 ml/min, obesity and MS treated by therapeutic exercise for 6 months. Patients completed a survey to assess their physical capacity and started with aerobic exercise training 5 times/week, 30 min/day for 6 months which could be gradually increased to 80 min/day and combined with strength exercise, prescribed by a physiotherapist. Aerobic exercise consisted of walking, swimming, or cycling. Resistance exercises involved the use of external weights or one's own body weight to perform movements. An adherence plan was implemented, including weekly calls, monthly visits and an activity tracker to collect objective data. We evaluated changes in measured GFR with iohexol-DBS and albuminuria and metabolic outcomes: weight, tryglycerides, blood pressure, HbA1c, etc. Biochemical, anthropometric and renal function were performed every 3 months. Due to the limited evidence on exercise in CKD and MS, we conducted an exploratory study to assess its effects, which can serve as a basis for designing long-term trials. Results Forty patients were evaluated. All were overweight or obese, mGFR was 58 ± 20 ml/min and urine albumin-creatinine ratio (UACR) 256 mg/g [IQR: 38–774]. Based on weight reduction (>5%), patients were classified as “responders” (n = 30) and “non-responders” (n = 10). Responders had a major reduction in body mass index (BMI) from 35 ± 4 to 31 ± 4 Kg/m² (P < 0.001), triglycerides (P < 0.001), HbA1c (P = 0.001), systolic and diastolic blood pressure (P = 0.033, P = 0.009) and UACR from 222 [20–610] to 89 [17–413] mg/g (P = 0.002), whereas mGFR diminished (≥7%) in half of them and remained stable in the other half. Non-responders showed no significant changes in weight, metabolic parameters, mGFR or UACR. The mean adherence (%) was higher in the responder group compared to the non-responder group (87 ± 10% vs. 57 ± 25%). Importantly, no major side effects were observed. Conclusion Therapeutic exercise is a safe and effective intervention for patients with CKD, obesity, and MS, with significant improvements in 75% of patients of this study. In terms of metabolic outcomes, exercise led to significant improvements in weight, triglycerides, HbA1c, and blood pressure. Albuminuria also decreased significantly, indicating potential cardiovascular and renal benefits. However, changes in mGFR were heterogeneous. Half of the patients who lost weight showed an early reduction in GFR, correcting hyperfiltration, whereas the other half, despite a similar weight reduction, did not. This underscores the need to better understand the impact of weight reduction on GFR changes in CKD. Adherence was key to achieving results, supported by personalized and supervised exercise protocols. More research in the field and long-term clinical trials are needed.

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