Randomized Controlled Trial of Exercise in CKD-The RENEXC Study

Kidney Int Rep. 2019 Apr 9;4(7):963-976. doi: 10.1016/j.ekir.2019.04.001. eCollection 2019 Jul.


Introduction: Home-based, clinically feasible trials in non-dialysis-dependent patients with chronic kidney disease (CKD) are sparse. We compared the effects of 2 different exercise training programs on physical performance, and measured glomerular filtration rate (mGFR) and albuminuria level in patients with CKD stages 3 to 5.

Methods: This is a single-center, randomized controlled trial (RCT) comprising 151 patients (mGFR: 22 ± 8 ml/min per 1.73 m2; age 66 ± 14 years) randomized to either balance or strength training. Both groups were prescribed 30 minutes of exercise per day for 5 days per week for 12 months, comprising 60 minutes per week of endurance training and 90 minutes per week of either strength or balance exercises. The exercises were individually prescribed, and the intensity was monitored with Borg's rating of perceived exertion (RPE).

Results: There were no treatment differences for any of the primary outcomes measuring physical performance. The strength and balance groups showed significantly increased effect sizes after 12 months for the following: walking (31 m and 24 m, P < 0.001) and the 30-second sit-to-stand test (both: 1 time, P < 0.001); quadriceps strength (right/left: strength 1.2/0.8 kg*m, P < 0.003; balance 0.6/0.9, P < 0.01); functional reach (both: 2 cm, P < 0.01); and fine motor skills (open/closed eyes, right/left, both: between 0.3 and 4 seconds faster, P < 0.05). After 12 months, there was a significant treatment difference for albuminuria (P < 0.02), which decreased by 33% in the strength group. In both groups, mGFR declined by 1.8 ml/min per 1.73 m2.

Conclusion: Our primary hypothesis that strength training was superior to balance training was not confirmed. Within groups, 12 months of exercise training resulted in significant improvements in most measures of physical performance. Measured GFR declined similarly in the 2 groups. The strength group showed a significant decrease in albuminuria.

Keywords: albuminuria; chronic kidney disease; exercise training; glomerular filtration rate; physical performance; randomized controlled trial.