Does exercise improve health outcomes in people with Chronic Kidney Disease?

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Written by Marissa Hoen | November 2 2020

This past week I have been doing lots of digging in the scientific literature around all things Kidney and Exercise, thanks to inspiration from my Exercise Physiology course. Some research surprised me, such as the prevalence of Chronic Kidney Disease (CKD). The number of individuals diagnosed with CKD continues to increase, with a global prevalence of about 11-13%1. Both a cause and consequence of CKD includes diabetes and hypertension- and each of these conditions can be improved by exercise2!

What is Chronic Kidney Disease?

  • CKD is defined as structural or functional damage to the kidneys for 3 months or more3

    • Identified through increased blood creatinine, immune factors, and proteinuria (proteins excreted in the urine)3

  • Symptoms are not common in early stages, so regular Doctor’s visits are important for those with cardiovascular or other health concerns

  • Some Later Stage symptoms include4:

    • Water retention leading to swollen ankles or hands

    • Shortness of breath

    • Fatigue

    • Muscle Cramps

    • Weight Loss and Poor Appetite

    • Blood in your urine (hematuria) 

    • Headaches

What do the Kidneys actually do?5

  • The Kidneys main function is to filter our blood!

    • The kidneys remove waste products that our cells make including creatinine, uric acid, and urea

    • They also filter out excess substances like extra water, sodium, potassium, phosphorus, to be excreted in urine

  • In addition to filtering, the Kidneys regulate many characteristics of the blood including:

    • Blood pH

    • Blood Volume 

    • Blood Pressure

How does exercise impact people with CKD?6

Exercise has been shown to slow kidney disease progression primarily through its influence on other body systems, including the cardiovascular and muscular systems, however there is notable . Exercise promotes:

  • Decreased systemic inflammation​

  • Lower Blood Pressure​

  • Less blood flow to kidneys during exercise- easing the blood pressure on the kidneys

  • Decreased arterial stiffness​- easing the workload of your heart, helping to lower blood pressure at the kidneys

  • Increased muscle mass

  • Increased tolerance to exercise

  • Improved quality of life

  • So much more!

Precautions to exercise:

  • If you were diagnosed with CKD, you may be taking medications such as beta-blockers to help lower your blood pressure. Keep in mind that these lower your heart rate as well, so if you are measuring exercise intensity with your heart rate, you may be unable to reach your target heart rate. 

  • Make sure you take time to warm up before your workout to help moderate the rise in blood pressure!

  • Some researchers suggest sticking to a continuous moderate intensity aerobic exercise with some lighter resistance training, however new research suggests that more high intensity exercise may be safe for people with CKD8.

  • As always, talk with your doctor before beginning a new exercise program to ask about hydration levels, exercise-medication interactions, and any other concerns you may have. 

Summary:

Exercise has shown to improve health outcomes and quality of life in people with Chronic Kidney Disease. Keep it moving for the health of your kidneys!

References

  1. Hill, N., Fatoba, S., Oke, J., Hirst, J., O’Callaghan, C., Lasseron, D., & Hobbs, F. (2016). Global prevalence of chronic kidney disease- A systematic review and meta-analysis. PLoS One, 11(7), e0158765. https://doi.org/10.1371/journal.pone.015876

  2. Barcellos, F. C., Santos, I. S., Umpierre, D., Bohlke, M., & Hallal, P. C. (2015). Effects of exercise in the whole spectrum of chronic kidney disease: a systematic review. Clinical kidney journal, 8(6), 753–765. https://doi.org/10.1093/ckj/sfv099

  3. Matovinović, M. S. (2009). 1. Pathophysiology and Classification of Kidney Diseases. EJIFCC, 20(1), 2–11.

  4. Symptoms chronic kidney disease. (2019, August 29). NHS. Retrieved October 31, 2020, from https://www.nhs.uk/conditions/kidney-disease/symptoms/

  5. Derrickson, B. (2017). Human Physiology (4 ed.). John Wiley & Sons, Inc.

  6. Gould, D. W., Graham-Brown, M. P., Watson, E. L., Viana, J. L., & Smith, A. C. (2014). Physiological benefits of exercise in pre-dialysis chronic kidney disease. Nephrology (Carlton, Vic.), 19(9), 519-527. doi:10.1111/nep.12285

  7. Sheps, S. (2020, February 12). Beta blockers: How do they affect exercise? Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/beta-blockers/faq-20058369

  8. Beetham, K. S., Howden, E. J., Fassett, R. G., Petersen, A., Trewin, A. J., Isbel, N. M., & Coombes, J. S. (2019). High‐intensity interval training in chronic kidney disease: A randomized pilot study. Scandinavian Journal of Medicine & Science in Sports, 29(8), 1197-1204. doi:10.1111/sms.13436

  9. Image credit can be found here: https://stock.adobe.com/ca/search?k=kidney+cartoon&asset_id=307567493