Abstract: FR-OR06
Exercise Training and Progression of CKD (GFR-Ex): A Randomized Controlled Feasibility Study
Session Information
- CKD: Care Patterns and Novel Therapeutic Approaches
October 25, 2024 | Location: Room 25, Convention Center
Abstract Time: 05:20 PM - 05:30 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Davies, Mark, NHS Wales Cardiff and Vale University Health Board, Cardiff, United Kingdom
- Sandoo, Aamer, Institute for Applied Human Physiology, Bangor University, Bangor, United Kingdom
- Alejmi, Abdulfattah, NHS Wales Betsi Cadwaladr University Health Board, Bangor, United Kingdom
- Greenwood, Sharlene A., Department of Renal Medicine, King's College Hospital NHS Trust, London, United Kingdom
- Macdonald, Jamie Hugo, Institute for Applied Human Physiology, Bangor University, Bangor, United Kingdom
Background
Whether exercise intervention can delay kidney function decline is not known. The GFR-Ex study assessed the feasibility of a 12-month exercise training program to attenuate the rate of decline in isotope-measured (mGFR) and estimated (eGFR) Glomerular Filtration Rate.
Methods
In a multicenter feasibility study, people with stage 3-4 kidney disease (CKD) with declining function were randomized to either 12 months exercise training (home-based aerobic and resistance program) or usual care. The primary outcome was feasibility, assessed by recruitment and retention rates, intervention adherence (target >80%), and harms. Scientific feasibility outcomes included difference in mGFR (99Tcm-DTPA injection) between groups at 12 months; eGFR decline (cystatin C and creatinine method); and comparison between mGFR and eGFR.
Results
Between December 2018 and July 2022, 2260 patients were screened. Seventy-four participants were randomized (mean age (SD): 56 (14) years; eGFR: 34 (13) ml/min/1.73m2; 62% male; 61% white) and 34 completed the study (11 exercise,; 23 control). The screening eligibility rate was 11%, consent rate was 48%, and 12-month retention rate was 43% (COVID-19 was implicated in 23% of participants who withdrew). The median (IQR) exercise sessions completed was 69 (63.0, 72.0) %. No adverse events related to the exercise program were recorded. The mGFR and eGFR data are shown in Table. The mean difference (eGFR minus mGFR) was -1.6 ml/min/1.73 m2 (95% CI: -2.6 to -0.6); the 95% limits of agreement were 8.8 and -11.7 ml/min/1.73 m2.
Conclusion
In people with progressive, moderate CKD, a 12-month exercise training program was safe and feasible. High dropout and low exercise adherence were in part due to the COVID pandemic. Scientific feasibility was suggested by an encouraging trend for exercise to attenuate GFR decline, and eGFR being a practical and sufficiently accurate alternative to mGFR. This study supports that progression to a definitive trial is warranted, provided modifications (e.g. use of a telehealth exercise intervention) are made to enhance participant recruitment, retention and exercise adherence.
| Outcome Measure | Exercise group | Usual care group |
| Measured GFR at 12 months (ml/min/1.73 m2) | 36.1 (12.1) | 33.8 (14.7) |
| eGFR decline between 0 & 12 months (ml/min/1.73 m2/year) | -3.9 (3.4) | -5.1 (6.5) |
Values are mean (SD)
Funding
- Private Foundation Support