Therapeutic exercise on metabolic and renal outcomes in patients with Chronic Kidney Disease (CKD): A narrative review.

BACKGROUND: Chronic Kidney Disease (CKD) affects 11-13% of the world population. The main risk factors for CKD include diabetes, hypertension, and obesity. Metabolic syndrome is associated with the onset of CKD in the non-diabetic population. Obesity and metabolic syndrome are also risk factors for a worse progression of established CKD. Therapeutic exercise is an effective option to treat and manage obesity, metabolic syndrome and diabetes in the general population. However, the evidence on the effect of exercise in patients with CKD, obesity and metabolic syndrome is scarce.

SUMMARY: We evaluated available evidence on the effect of therapeutic exercise in patients with chronic kidney disease (CKD), excluding dialysis, particularly in improving metabolic risk factors and main renal outcomes: renal function loss and albuminuria/proteinuria. This review includes prospective studies and clinical trials. A total of 44 studies were analysed in 1700 subjects with renal disease (2-5), including patients with renal transplantation. Most studies did not prove a major effect of exercise on albuminuria/proteinuria, glomerular filtration rate, obesity, or metabolic syndrome. These results are intriguing and deserve attention. The exploratory nature of most studies, including a low number of cases and short follow-up, might explain the lack of efficacy of exercise in our analysis. Specific aspects like the type of exercise, frequency, intensity, duration, accommodation during follow-up, individualization, safety, and adherence are crucial to the success of therapeutic exercise. The beneficial role of exercise in patients with CKD remains to be determined.

KEY MESSAGES: - The effect of therapeutic exercise on renal and metabolic outcomes in patients with CKD remain to be determined. - According to the evidence selected, therapeutic exercise seems to be safe to treat patients with CKD. - Most studies are exploratory by nature, with results that need further investigation. - Therapeutic exercise is a complex procedure that must be specifically designed to treat patients with CKD.