Kidney Week

Abstract: FR-OR35

Efficacy of a Remote Exercise Program on Fatigue in Persons with CKD

Session Information

• Exercise and Kidney Health: From Bench to Smartphone
  October 25, 2024 | Location: Room 4, Convention Center
  Abstract Time: 05:40 PM - 05:50 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1500 Health Maintenance, Nutrition, and Metabolism

Authors

• Kim, Tae Youn, University of California Davis, Sacramento, California, United States

Tae Youn Kim, PhD, RN

• Hamdan, Hiba, University of California Davis, Sacramento, California, United States

Hiba Hamdan, MBBS

• Norman, Jennifer E., University of California Davis, Sacramento, California, United States

Jennifer E. Norman, MA, PhD

• Gipe, Jesse, University of California Davis, Sacramento, California, United States

Jesse Gipe

• Jue, Thomas, University of California Davis, Sacramento, California, United States

Thomas Jue, PhD

• Begue, Gwenaelle, California State University Sacramento, Sacramento, California, United States

Gwenaelle Begue, PhD

• Gamboa, Jorge, Vanderbilt University, Nashville, Tennessee, United States

Jorge Gamboa, MD, PhD

• Roshanravan, Baback, University of California Davis, Sacramento, California, United States

Baback Roshanravan, MD, MS, MPH, FASN

Background

Physical frailty and fatigue are prevalent in persons with chronic kidney disease (CKD), contributing to poor quality of life and increased morbidity and mortality risk. While previous studies show positive impact of exercise programs on reducing inflammation and fatigue, little is known about the efficacy of a structured exercise program on immune cell mitochondrial bioenergetics and fatigue in persons with CKD.

Methods

We conducted a pilot randomized (3:1) clinical trial of a 12-week video-supervised individualized exercise program (NCT02923063). Outcomes include 1) aerobic exercise capacity (measured with a total distance of a 6-minute walk test (6MWT)), 2) peripheral blood mononuclear cells (PBMC) mitochondrial bioenergetics (measured using the high resolution respirometry), and 3) fatigue measured using a 13-item validated scale (FACIT-Fatigue). We classified exercise responders by performance on 6MWT (>=17meters). Linear mixed effects models were used to examine the association of exercise with PBMC bioenergetics and fatigue adjusting for depressive mood measured with the 8-item PROMIS Depression scale.

Results

Of 30 participants with CKD, nine were randomized in the usual care group (UC) and 21 in the exercise group (EX). No difference was found at baseline between the groups in sex (60% male), diabetes (47%), age (64±10 years), eGFR (34±12ml/min per 1.73m²), depression (47±8.4), fatigue (38±10), and 6MWT (463±88 meters). We also found no difference in the mean values of PBMC ATP-linked respiration between the UC (1.1±0.5 pmol O2/min/10K cells) and EX (1.2±0.8) at baseline. With a mean change of 17 meters or greater for 6MWT, 12 of the 21 EX improved exercise capacity and reduced fatigue (a mean difference: 5.13, 95% CI[0.44, 9.81], p=0.03) at follow-up. Further adjustment for depression showed that each 1 standard deviation decline in PBMC ATP-linked respiration was associated with a 14-point decrease in fatigue (95%CI[-24.52, -3.48] , p=0.009).

Conclusion

Among responders to our exercise program with improved 6MWT, exercise program reduced fatigue which was inversely correlated with PBMC ATP-linked respiration. Further investigation is needed to examine long-term effects of exercise on ameliorating mitochondrial dysfunction and its links to inflammation responses and fatigue in a larger cohort of CKD.

Funding

• NIDDK Support