Twelve months of exercise training did not halt abdominal aortic calcification in patients with CKD - a sub-study of RENEXC-a randomized controlled trial

BMC Nephrol. 2020 Jun 22;21(1):233. doi: 10.1186/s12882-020-01881-y.

Abstract

Background: Arteriosclerosis is prevalent in patients with chronic kidney disease (CKD). Our aims were to investigate (1) the effects of 12 months of either balance- or strength- both in combination with endurance training on abdominal aortic calcification (AAC); on some lipids and calcific- and inflammatory markers; and (2) the relationships between the change in AAC score and these markers in non-dialysis dependent patients with CKD stages 3 to 5.

Methods: One hundred twelve patients (mean age 67 ± 13 years), who completed 12 months of exercise training; comprising either balance- or strength training, both in combination with endurance training; with a measured glomerular filtration rate (mGFR) 22.6 ± 8 mL/min/1.73m2, were included in this study. AAC was evaluated with lateral lumbar X-ray using the scoring system described by Kauppila. Plasma fetuin-A, fibroblast growth factor 23 (FGF23) and interleukin 6 (IL6) were measured with Enzyme-linked immunosorbent assay (ELISA) kits.

Results: After 12 months of exercise training, the AAC score increased significantly in both groups; mGFR and lipoprotein (a) decreased significantly in both groups; parathyroid hormone (PTH) and 1,25(OH)2D3 increased significantly only in the strength group; fetuin-A increased significantly only in the balance group. Plasma triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, FGF23, phosphate, calcium, IL6, C-reactive protein (CRP), albumin were unchanged. The increase in AAC score was positively related to ageing and the levels of baseline triglycerides and lipoprotein (a).

Conclusions: Exercise training did not prevent the progression of AAC; it might have contributed to the reduced levels of lipoprotein (a) and unchanged levels of calcific- and inflammatory markers in these patients with non-dialysis dependent CKD. Hypertriglyceridemia, high levels of lipoprotein (a) and ageing emerged as longitudinal predictors of vascular calcification in these patients.

Trial registration: NCT02041156 at www.ClinicalTrials.gov. Date of registration: January 20, 2014. Retrospectively registered.

Keywords: Abdominal aortic calcification; Arteriosclerosis; CKD; Exercise training; Lipids.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aorta, Abdominal / diagnostic imaging
  • Aortic Diseases / complications
  • Aortic Diseases / diagnostic imaging
  • Aortic Diseases / metabolism
  • Aortic Diseases / therapy*
  • Calcitriol / metabolism
  • Disease Progression
  • Endurance Training / methods*
  • Exercise Therapy / methods
  • Female
  • Fibroblast Growth Factor-23
  • Fibroblast Growth Factors / metabolism
  • Glomerular Filtration Rate
  • Humans
  • Interleukin-6 / metabolism
  • Lipoprotein(a) / metabolism
  • Male
  • Middle Aged
  • Parathyroid Hormone / metabolism
  • Postural Balance
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / metabolism*
  • Resistance Training / methods*
  • Triglycerides / metabolism
  • Vascular Calcification / complications
  • Vascular Calcification / diagnostic imaging
  • Vascular Calcification / metabolism
  • Vascular Calcification / therapy*
  • alpha-2-HS-Glycoprotein / metabolism

Substances

  • FGF23 protein, human
  • IL6 protein, human
  • Interleukin-6
  • Lipoprotein(a)
  • Parathyroid Hormone
  • Triglycerides
  • alpha-2-HS-Glycoprotein
  • Fibroblast Growth Factors
  • Fibroblast Growth Factor-23
  • Calcitriol

Associated data

  • ClinicalTrials.gov/NCT02041156