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Erschienen in: Clinical and Experimental Nephrology 5/2019

07.02.2019 | Original article

Effect of exercise intensity on renal blood flow in patients with chronic kidney disease stage 2

verfasst von: Kazuko Kotoku, Tetsuhiko Yasuno, Shotaro Kawakami, Kanta Fujimi, Takuro Matsuda, Shihoko Nakashima, Yoshinari Uehara, Hiroaki Tanaka, Takao Saito, Yasuki Higaki

Erschienen in: Clinical and Experimental Nephrology | Ausgabe 5/2019

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Abstract

Background

Acute exercise reduces renal blood flow (RBF). However, the effect of exercise intensity on RBF in patients with chronic kidney disease (CKD) stage 2 is not known. We investigated the association between RBF and exercise intensity in patients with CKD stage 2 using pulsed Doppler ultrasonography.

Methods

Eight men with CKD stage 2 (cystatin C-based estimate of glomerular filtration rate: 60–89 ml/min/1.73 m2) participated in this study. Using a bicycle ergometer, participants undertook a maximal graded exercise test (MGET) (experiment 1) and a multi-stage exercise test (experiment 2) to determine their lactate threshold (LT). Participants undertook a multi-stage exercise test for 4-min each. Workloads of 60%, 80%, 100%, 120%, and 140% of LT were used in experiment 3. RBF was measured by pulsed Doppler ultrasonography at rest, immediately after exercise, and 1 h after exercise in experiment 1, and at rest and immediately after each exercise bout in experiment 3.

Results

Renal blood flow after the MGET was 52% lower than at rest, and did not recover as well as after the exercise test. Cross-sectional area (CSA) was significantly lower after graded exercise. RBF tended to be lower at 100% of LT and was significantly lower at 120% of LT. CSA was significantly lower at 100% of LT.

Conclusions

Renal blood flow does not change during exercise until the LT is reached. These findings may assist in making appropriate exercise recommendations to patients with CKD stage 2.
Literatur
1.
Zurück zum Zitat Imai E, Horio M, Iseki K, Yamagata K, Watanabe T, Hara S, Ura N, Kiyohara Y, Hirakata H, Moriyama T, Ando Y, Nitta K, Inaguma D, Narita I, Iso H, Wakai K, Yasuda Y, Tsukamoto Y, Ito S, Makino H, Hishida A, Matsuo S. Prevalence of chronic kidney disease (CKD) in the Japanese general population predicted by the MDRD equation modified by a Japanese coefficient. Clin Exp Nephrol. 2007;11:156–163.CrossRefPubMed Imai E, Horio M, Iseki K, Yamagata K, Watanabe T, Hara S, Ura N, Kiyohara Y, Hirakata H, Moriyama T, Ando Y, Nitta K, Inaguma D, Narita I, Iso H, Wakai K, Yasuda Y, Tsukamoto Y, Ito S, Makino H, Hishida A, Matsuo S. Prevalence of chronic kidney disease (CKD) in the Japanese general population predicted by the MDRD equation modified by a Japanese coefficient. Clin Exp Nephrol. 2007;11:156–163.CrossRefPubMed
2.
Zurück zum Zitat Japanese Society of Nephrology. Evidence-based clinical practice guideline for CKD 2013. Clin Exp Nephrol. 2014;18:346–423.CrossRef Japanese Society of Nephrology. Evidence-based clinical practice guideline for CKD 2013. Clin Exp Nephrol. 2014;18:346–423.CrossRef
3.
Zurück zum Zitat Foley RN, Murray AM, Li S, Herzog CA, McBean AM, Eggers PW, Collins AJ. Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999. J Am Soc Nephrol. 2005;16:489–95.CrossRefPubMed Foley RN, Murray AM, Li S, Herzog CA, McBean AM, Eggers PW, Collins AJ. Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999. J Am Soc Nephrol. 2005;16:489–95.CrossRefPubMed
4.
Zurück zum Zitat Michishita R, Matsuda T, Kawakami S, Kiyonaga A, Tanaka H, Morito N, Higaki Y. The association between unhealthy lifestyle behaviors and the prevalence of chronic kidney disease (CKD) in middle-aged and older men. J Epidemiol. 2016;26:378–85.CrossRefPubMed Michishita R, Matsuda T, Kawakami S, Kiyonaga A, Tanaka H, Morito N, Higaki Y. The association between unhealthy lifestyle behaviors and the prevalence of chronic kidney disease (CKD) in middle-aged and older men. J Epidemiol. 2016;26:378–85.CrossRefPubMed
5.
Zurück zum Zitat Beddhu S, Baird BC, Zitterkoph J, Neilson J, Greene T. Physical activity and mortality in chronic kidney disease (NHANES III). Clin J Am Soc Nephrol. 2009;4:1901–6.CrossRefPubMedPubMedCentral Beddhu S, Baird BC, Zitterkoph J, Neilson J, Greene T. Physical activity and mortality in chronic kidney disease (NHANES III). Clin J Am Soc Nephrol. 2009;4:1901–6.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, Tamura MK, Feldman HI. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014;63:713–35.CrossRefPubMed Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, Tamura MK, Feldman HI. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014;63:713–35.CrossRefPubMed
7.
Zurück zum Zitat National Kidney Foundation. KDOQI clinical practice guideline for diabetes and CKD: 2012 update. Am J Kidney Dis. 2012;60:850–86.CrossRef National Kidney Foundation. KDOQI clinical practice guideline for diabetes and CKD: 2012 update. Am J Kidney Dis. 2012;60:850–86.CrossRef
8.
Zurück zum Zitat Poortsmans JR. Exercise and renal function. Sports Med. 1984;1:125–53.CrossRef Poortsmans JR. Exercise and renal function. Sports Med. 1984;1:125–53.CrossRef
9.
Zurück zum Zitat Castenfors J. Renal function during exercise. Acta Physiol Scand. 1967;70(Suppl. 293):1–44. Castenfors J. Renal function during exercise. Acta Physiol Scand. 1967;70(Suppl. 293):1–44.
10.
11.
Zurück zum Zitat Grimby G. Renal clearances during prolonged supine exercise at different loads. J Appl Physiol. 1965;20:1294–8.CrossRef Grimby G. Renal clearances during prolonged supine exercise at different loads. J Appl Physiol. 1965;20:1294–8.CrossRef
12.
Zurück zum Zitat Suzuki M. Physical exercise and renal function. J Phys Fit Sports Med. 2015;4:17–29.CrossRef Suzuki M. Physical exercise and renal function. J Phys Fit Sports Med. 2015;4:17–29.CrossRef
14.
Zurück zum Zitat Johansen KL. Exercise and chronic kidney disease current recommendations. Sport Med. 2005;35:485–99.CrossRef Johansen KL. Exercise and chronic kidney disease current recommendations. Sport Med. 2005;35:485–99.CrossRef
15.
Zurück zum Zitat Kirkman D, Edwards DG, Lennon-Edwards S. Exercise as an adjunct therapy in chronic kidney disease. Renal Nutr Forum. 2014;33:1–8.PubMedPubMedCentral Kirkman D, Edwards DG, Lennon-Edwards S. Exercise as an adjunct therapy in chronic kidney disease. Renal Nutr Forum. 2014;33:1–8.PubMedPubMedCentral
16.
17.
Zurück zum Zitat Momen A, Leuenberger UA, Ray CA, Cha S, Handly B, Sinoway LI. Renal vascular responses to static handgrip: role of muscle mechanoreflex. Am J Physiol Heart Circ Physiol. 2003;285:H1247–53.CrossRefPubMed Momen A, Leuenberger UA, Ray CA, Cha S, Handly B, Sinoway LI. Renal vascular responses to static handgrip: role of muscle mechanoreflex. Am J Physiol Heart Circ Physiol. 2003;285:H1247–53.CrossRefPubMed
18.
Zurück zum Zitat Momen A, Bower D, Leuenberger UA, Boehmer J, Lerner S, Alfrey EJ, Handly B, Sinoway LI. Renal vascular response to static handgrip exercise: sympathetic vs. autoregulatory control. Am J Physiol Heart Circ Physiol. 2005;289:H1770–6.CrossRefPubMed Momen A, Bower D, Leuenberger UA, Boehmer J, Lerner S, Alfrey EJ, Handly B, Sinoway LI. Renal vascular response to static handgrip exercise: sympathetic vs. autoregulatory control. Am J Physiol Heart Circ Physiol. 2005;289:H1770–6.CrossRefPubMed
19.
Zurück zum Zitat Endo MY, Suzuki R, Nagahata N, Hayashi N, Miura A, Koga S, Fukuba Y. Differential arterial blood flow response of splanchnic and renal organs during low-intensity cycling exercise in women. Am J Physiol Heart Circ Physiol. 2008;294:H2322–6.CrossRefPubMed Endo MY, Suzuki R, Nagahata N, Hayashi N, Miura A, Koga S, Fukuba Y. Differential arterial blood flow response of splanchnic and renal organs during low-intensity cycling exercise in women. Am J Physiol Heart Circ Physiol. 2008;294:H2322–6.CrossRefPubMed
20.
Zurück zum Zitat Lesley AS, Josef C, Christopher HS, Harold IF, Marc F, John K, Jerome R, Frederick VL, Robert DB, Yaping Z, Tom G, Andrew SL. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3418 individuals with CKD. Am J Kidney Dis. 2008;51(3):395–406.CrossRef Lesley AS, Josef C, Christopher HS, Harold IF, Marc F, John K, Jerome R, Frederick VL, Robert DB, Yaping Z, Tom G, Andrew SL. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3418 individuals with CKD. Am J Kidney Dis. 2008;51(3):395–406.CrossRef
21.
Zurück zum Zitat Horio M, Imai E, Yasuda Y, Matsuo S, et al. GFR estimation using standardized serum cystatin C in Japan. Am J Kidney Dis. 2013;61(2):197–203.CrossRef Horio M, Imai E, Yasuda Y, Matsuo S, et al. GFR estimation using standardized serum cystatin C in Japan. Am J Kidney Dis. 2013;61(2):197–203.CrossRef
22.
Zurück zum Zitat Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53(6):982–92.CrossRef Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53(6):982–92.CrossRef
23.
Zurück zum Zitat Suzuki M. Exercise and renal function. Adv Ex Sports Physiol. 1996;2:45–56. Suzuki M. Exercise and renal function. Adv Ex Sports Physiol. 1996;2:45–56.
24.
Zurück zum Zitat Ueda J, Nakanishi H, Miyazaki M. Effects of glucagon on the renal hemodynamics of dogs. Jpn Circ J. 1977;41:991–6.CrossRefPubMed Ueda J, Nakanishi H, Miyazaki M. Effects of glucagon on the renal hemodynamics of dogs. Jpn Circ J. 1977;41:991–6.CrossRefPubMed
25.
Zurück zum Zitat Monika JB, et al. Specificity and sensitivity of commercially available assays for glucagon and oxyntomodulin measurement in humans. Eur J Endocrinol. 2014;170:529–38.CrossRef Monika JB, et al. Specificity and sensitivity of commercially available assays for glucagon and oxyntomodulin measurement in humans. Eur J Endocrinol. 2014;170:529–38.CrossRef
26.
Zurück zum Zitat Brenner BM, Garcia DL, Anderson S. Glomeruli and blood pressure. Less of one, more the other? Am J Hypertens. 1988;1:335–47.CrossRef Brenner BM, Garcia DL, Anderson S. Glomeruli and blood pressure. Less of one, more the other? Am J Hypertens. 1988;1:335–47.CrossRef
27.
Zurück zum Zitat Anderson S, Meyer TW, Rennke HG, Brenner BM. Control of glomerular hypertension limits glomerular injury in rats with reduced renal mass. J Clin Invest. 1985;76:612–9.CrossRefPubMedPubMedCentral Anderson S, Meyer TW, Rennke HG, Brenner BM. Control of glomerular hypertension limits glomerular injury in rats with reduced renal mass. J Clin Invest. 1985;76:612–9.CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Tanaka H, Shindo M, Gutkowska J, Kinoshita A, Urata H, Ikeda M, Arakawa K. Effect of acute exercise on plasma immunoreactive—Atrial natriuretic factor. Life Sci. 1986;39:1685–93.CrossRefPubMed Tanaka H, Shindo M, Gutkowska J, Kinoshita A, Urata H, Ikeda M, Arakawa K. Effect of acute exercise on plasma immunoreactive—Atrial natriuretic factor. Life Sci. 1986;39:1685–93.CrossRefPubMed
29.
Zurück zum Zitat Sanders LR. Exercise-induced acute renal failure associated with ibuprofen, hydrochlorothiazide, and triamterene. J Am Soc Nephrol. 1995;5:2020–3.PubMed Sanders LR. Exercise-induced acute renal failure associated with ibuprofen, hydrochlorothiazide, and triamterene. J Am Soc Nephrol. 1995;5:2020–3.PubMed
Metadaten
Titel
Effect of exercise intensity on renal blood flow in patients with chronic kidney disease stage 2
verfasst von
Kazuko Kotoku
Tetsuhiko Yasuno
Shotaro Kawakami
Kanta Fujimi
Takuro Matsuda
Shihoko Nakashima
Yoshinari Uehara
Hiroaki Tanaka
Takao Saito
Yasuki Higaki
Publikationsdatum
07.02.2019
Verlag
Springer Singapore
Erschienen in
Clinical and Experimental Nephrology / Ausgabe 5/2019
Print ISSN: 1342-1751
Elektronische ISSN: 1437-7799
DOI
https://doi.org/10.1007/s10157-018-01685-3

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