Os efeitos do exercício aeróbico sobre os parâmetros bioquímicos em indivíduos com DRC em hemodiálise: Um estudo longitudinal
DOI:
https://doi.org/10.7322/jhgd.v30.10374Palavras-chave:
Doença renal crônica, Hemodiálise, Parâmetros sanguíneos, Exercícios aeróbicosResumo
Introdução: A doença renal crônica está diretamente relacionada a distúrbios cardiovasculares. Exercícios físicos guiados melhoram significativamente os efeitos adversos do tratamento dialítico.
Objetivo: Analisar as alterações nos parâmetros bioquímicos de indivíduos com doença renal crônica submetidos a exercícios moderados durante a hemodiálise.
Método: Este é um estudo experimental composto por 54 indivíduos submetidos à hemodiálise, divididos em um grupo controle e um grupo com intervenção. O grupo experimental passou por três sessões semanais de exercício aeróbico, realizadas durante as sessões de hemodiálise, com duração de 30 minutos, por 12 semanas. Os parâmetros sanguíneos de ambos os grupos foram comparados.
Resultados: Diferenças estatisticamente significativas foram observadas entre o protocolo pré (p=0,001) e pós-exercício para urea (p=0,006), cálcio (p=0,001), alanina aminotransferase (p=0,020) e sódio (p=&0.001). No grupo controle, observamos diferenças significativas para a variável cálcio (p<0.001), alanina aminotransferase (p=0,024), hematócrito (p=0,015), cálcio vs fósforo (p=0,018) e sódio (p=0,023), antes e depois do período.
Conclusão: O treinamento aeróbico durante a hemodiálise foi capaz de manter a estabilidade do nível sanguíneo em pacientes com doença renal crônica, tanto durante quanto no final do protocolo, considerando mesmo o aumento do fluxo sanguíneo. Este ensaio está registrado no registro brasileiro de Ensaios Clínicos - número RBR-7354r6. Data de inscrição: 5 de julho de 2018 às 12h59. Última atualização: 24 de julho de 2018 às 10h24. Identificação do teste - UTN Número: U1111-1216-8272.
Referências
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24. Fuhro MI, Dorneles GP, Andrade FP, Romao PRT, Peres A, Monteiro MB. Acute exercise during hemodialysis prevents the decrease in natural killer cells in patients with chronic kidney disease: a pilot study. Int Urol Nephrol. 2018;50(3):527-34. DOI: DOI: http://doi.org/10.1007/s11255-017-1747-z
25. Musavian AS, Soleimani A, Masoudi Alavi N, Baseri A, Savari F. Comparing the effects of active and passive intradialytic pedaling exercises on dialysis efficacy, electrolytes, hemoglobin, hematocrit, blood pressure and health-related quality of life. Nurs Midwifery Stud. 2015;4(1):e25922. DOI: http://doi.org/10.17795/nmsjournal25922
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27. Vaithilingam I, Polkinghorne KR, Atkins RC, Kerr PG. Time and exercise improve phosphate removal in hemodialysis patients. Am J Kidney Dis. 2004;43(1):85-9. DOI: http://doi.org/10.1053/j.ajkd.2003.09.016
28. Dinkova-Kostova AT, Abramov AY. The emerging role of Nrf2 in mitochondrial function. Free Radic Biol Med. 2015;88(Pt B):179-88. DOI: http://doi.org/10.1016/j.freeradbiomed.2015.04.036
29. Scarpulla RC. Nuclear control of respiratory chain expression by nuclear respiratory factors and PGC-1-related coactivator. Ann N Y Acad Sci. 2008;1147:321-34. DOI: http://doi.org/10.1196/annals.1427.006
30. Sette LHBC, Lopes EPA. Liver enzymes serum levels in patients with chronic kidney disease on hemodialysis: a comprehensive review. Clinics (Sao Paulo, Brazil). 2014;69(4):271-8. DOI: http://doi.org/10.6061/clinics/2014(04)09
31. Small DM, Beetham KS, Howden EJ, Briskey DR, Johnson DW, Isbel NM, et al. Effects of exercise and lifestyle intervention on oxidative stress in chronic kidney disease. Redox Rep. 2017;22(3):127-36. DOI: http://doi.org/10.1080/13510002.2016.1276314
32. Santana DA, Poortmans JR, Dorea EL, Machado JBA, Fernandes AL, Sá-Pinto AL, et al. Acute exercise does not impair renal function in nondialysis chronic kidney disease patients regardless of disease stage. Am J Physiol Renal Physiol. 2017;313(2):F547-52. DOI: http://doi.org/10.1152/ajprenal.00131.2017
33. Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis. 1998;31(4):607-17. DOI: http://doi.org/10.1053/ajkd.1998.v31.pm9531176
2. Locatelli F, Del Vecchio L, Pozzoni P. The importance of early detection of chronic kidney disease. Nephrol Dial Transplant. 2002;17(suppl 11):2-7. DOI: http://doi.org/10.1093/ndt/17.suppl_11.2
3. Moinuddin I, Leehey DJ. A comparison of aerobic exercise and resistance training in patients with and without chronic kidney disease. Adv Chronic Kidney Dis. 2008;15(1):83-96. DOI: http://doi.org/10.1053/j.ackd.2007.10.004
4. Sietsema KE, Amato A, Adler SG, Brass EP. Exercise capacity as a predictor of survival among ambulatory patients with end-stage renal disease. Kidney Int. 2004;65(2):719-24. DOI: http://doi.org/10.1111/j.1523-1755.2004.00411.x
5. Knight EL, Ofsthun N, Teng M, Lazarus JM, Curhan GC. The association between mental health, physical function, and hemodialysis mortality. Kidney Int. 2003;63(5):1843-51. DOI: http://doi.org/10.1046/j.1523-1755.2003.00931.x
6. Heiwe S, Jacobson SH. Exercise Training in Adults With CKD: A Systematic Review and Meta-analysis. Am J Kidney Dis. 2014;64(3):383-93. DOI: http://doi.org/10.1053/j.ajkd.2014.03.020
7. Aoike DT, Baria F, Kamimura MA, Ammirati A, Mello MT, Cuppari L. Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease. Int Urol Nephrol. 2015;47(2):359-67. DOI: http://doi.org/10.1007/s11255-014-0894-8
8. Heiwe S, Jacobson SH. Exercise training for adults with chronic kidney disease. Cochrane Database Syst Rev. 2011;10(10):CD003236. DOI: http://doi.org/10.1002/14651858.CD003236.pub2
9. Ploeger HE, Takken T, Greef MHG, Timmons BW. The effects of acute and chronic exercise on inflammatory markers in children and adults with a chronic inflammatory disease: a systematic review. Exerc Immunol Rev. 2009;15(1):6-41
10. Powers SK, Jackson MJ. Exercise-induced oxidative stress: cellular mechanisms and impact on muscle force production. Physiol Rev. 2008;88(4):1243-76. DOI: http://doi.org/10.1152/physrev.00031.2007
11. Roxo RS, Xavier VB, Miorin LA, Magalhaes AO, Sens YA, Alves VL. Impact of neuromuscular electrical stimulation on functional capacity of patients with chronic kidney disease on hemodialysis. J Bras Nefrol. 2016;38(3):344-50. DOI: http://dx.doi.org/10.5935/0101-2800.20160052
12. Vargas-Mendoza N, Morales-Gonzalez A, Madrigal-Santillan EO, Madrigal-Bujaidar E, Alvarez-Gonzalez I, Garcia-Melo LF, et al. Antioxidant and Adaptative Response Mediated by Nrf2 during Physical Exercise. Antioxidants (Basel). 2019;8(6):196. DOI: http://dx.doi.org/10.3390/antiox8060196
13. Cartee GD, Hepple RT, Bamman MM, Zierath JR. Exercise Promotes Healthy Aging of Skeletal Muscle. Cell Metab. 2016;23(6):1034-47. DOI: http://dx.doi.org/10.1016/j.cmet.2016.05.007
14. Viana JL, Kosmadakis GC, Watson EL, Bevington A, Feehally J, Bishop NC, et al. Evidence for anti-inflammatory effects of exercise in CKD. J Am Soc Nephrol. 2014;25(9):2121-30. DOI: http://dx.doi.org/10.1681/ASN.2013070702
15. Sethna CB, Salerno AE, McBride MG, Shults J, Paridon SM, Sharma N, et al. Cardiorespiratory fitness in pediatric renal transplant recipients. Transplantation. 2009;88(3):395. DOI: http://dx.doi.org/10.1097/TP.0b013e3181aed7d1
16. Parsons TL, Toffelmire EB, King-VanVlack CE. The effect of an exercise program during hemodialysis on dialysis efficacy, blood pressure and quality of life in end-stage renal disease (ESRD) patients. Clin Nephrol. 2004;61(4):261-74. DOI: http://doi.org/10.5414/cnp61261
17. Abreu LC, Pereira VX, Silva RPM, Macedo Jr H, Bezerra IMP. The right to scientific information: one of the main elements of the unified health system. J Hum Growth Dev. 2017;27(3):258-61. DOI: http://dx.doi.org/10.7322/jhgd.141485
18. Bezerra IMP. Translational medicine and its contribution to public health. J Hum Growth Dev. 2017;27(1):6-9. DOI: http://dx.doi.org/10.7322/jhgd.127642
19. Moraes SDTA. Scientific method and research in health: orientation for professional practice. J Hum Growth Dev. 2019;29(1):5-9. DOI: http://dx.doi.org/10.7322/jhgd.157742
20. Morais MJD, Raimundo RD, Oliveira FS, Abreu LC, Bezerra IMP, Silva RPM, et al. Evaluation of the effects of aerobic training during hemodialysis on autonomic heart rate modulation in patients with chronic renal disease. Medicine (Baltimore). 2019;98(23):e15976. DOI: http://doi.org/10.1097/MD.0000000000015976
21. Morais MJD, Abreu LC, Oliveira FS, Bezerra IMP, Raimundo RD, Silva RPM, et al. Is aerobic exercise training during hemodialysis a reliable intervention for autonomic dysfunction in individuals with chronic kidney disease? A prospective longitudinal clinical trial. J Multidiscip Healthc. 2019;12:711-8. DOI: http://doi.org/10.2147/JMDH.S202889
22. Vecchi AF, Colucci P, Salerno F, Scalamogna A, Ponticelli C. Outcome of peritoneal dialysis in cirrhotic patients with chronic renal failure. Am J Kidney Dis. 2002;40(1):161-8. DOI: http://doi.org/10.1053/ajkd.2002.33925
23. Qiu Z, Zheng K, Zhang H, Feng J, Wang L, Zhou H. Physical Exercise and Patients with Chronic Renal Failure: A Meta-Analysis. Biomed Res Int. 2017;2017:7191826. DOI: http://doi.org/10.1155/2017/7191826
24. Fuhro MI, Dorneles GP, Andrade FP, Romao PRT, Peres A, Monteiro MB. Acute exercise during hemodialysis prevents the decrease in natural killer cells in patients with chronic kidney disease: a pilot study. Int Urol Nephrol. 2018;50(3):527-34. DOI: DOI: http://doi.org/10.1007/s11255-017-1747-z
25. Musavian AS, Soleimani A, Masoudi Alavi N, Baseri A, Savari F. Comparing the effects of active and passive intradialytic pedaling exercises on dialysis efficacy, electrolytes, hemoglobin, hematocrit, blood pressure and health-related quality of life. Nurs Midwifery Stud. 2015;4(1):e25922. DOI: http://doi.org/10.17795/nmsjournal25922
26. Mohseni R, Emami Zeydi A, Ilali E, Adib-Hajbaghery M, Makhlough A. The effect of intradialytic aerobic exercise on dialysis efficacy in hemodialysis patients: a randomized controlled trial. Oman Med J. 2013;28(5):345-9. DOI: http://doi.org/10.5001/omj.2013.99
27. Vaithilingam I, Polkinghorne KR, Atkins RC, Kerr PG. Time and exercise improve phosphate removal in hemodialysis patients. Am J Kidney Dis. 2004;43(1):85-9. DOI: http://doi.org/10.1053/j.ajkd.2003.09.016
28. Dinkova-Kostova AT, Abramov AY. The emerging role of Nrf2 in mitochondrial function. Free Radic Biol Med. 2015;88(Pt B):179-88. DOI: http://doi.org/10.1016/j.freeradbiomed.2015.04.036
29. Scarpulla RC. Nuclear control of respiratory chain expression by nuclear respiratory factors and PGC-1-related coactivator. Ann N Y Acad Sci. 2008;1147:321-34. DOI: http://doi.org/10.1196/annals.1427.006
30. Sette LHBC, Lopes EPA. Liver enzymes serum levels in patients with chronic kidney disease on hemodialysis: a comprehensive review. Clinics (Sao Paulo, Brazil). 2014;69(4):271-8. DOI: http://doi.org/10.6061/clinics/2014(04)09
31. Small DM, Beetham KS, Howden EJ, Briskey DR, Johnson DW, Isbel NM, et al. Effects of exercise and lifestyle intervention on oxidative stress in chronic kidney disease. Redox Rep. 2017;22(3):127-36. DOI: http://doi.org/10.1080/13510002.2016.1276314
32. Santana DA, Poortmans JR, Dorea EL, Machado JBA, Fernandes AL, Sá-Pinto AL, et al. Acute exercise does not impair renal function in nondialysis chronic kidney disease patients regardless of disease stage. Am J Physiol Renal Physiol. 2017;313(2):F547-52. DOI: http://doi.org/10.1152/ajprenal.00131.2017
33. Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis. 1998;31(4):607-17. DOI: http://doi.org/10.1053/ajkd.1998.v31.pm9531176
