The effectiveness of a comprehensive nutrition and exercise program on the risk for cardiovascular disease in patients with chronic kidney disease

Chronic kidney disease (CKD) affects a significant proportion of the population, and its incidence and prevalence is increasing. Cardiovascular disease (CVD) is the leading cause of death in this population. Nutrition and exercise each play an important role in decreasing the cardiovascular risk factors that are commonly seen in patients with CKD. However, there is limited information available regarding the combined effects of both nutrition and exercise for improvement in cardiovascular risk factors and health status of individuals with pre-dialysis CKD. The primary purpose of this research was to determine whether a comprehensive nutrition and exercise program reduces the risk for CVD in persons with CKD, compared to a control CKD population not enrolled in the program. We recruited 36 pre-dialysis CKD patients, 21 of whom were randomized to the intervention program, and 15 of whom were randomized to the control group. Participants of the exercise group attended a 5-week “cooking with kidney disease” course and a 1-week shopping tour with a Registered Dietitian. The participants then engaged in a 12-week supervised exercise training program. The control group received usual care for CKD. Patients were assessed at baseline, post-nutrition, and post-exercise. During these days measurements of anthropometric and musculoskeletal fitness, resting measures of cardiovascular health, and results of a sub-maximal aerobic test were collected. No significant improvements were seen in BMI, waist circumference, sum of 5 skinfolds, or musculoskeletal fitness measures (grip strength or flexibility). Participants in the experimental group showed significant improvements in VO2max post-intervention when compared to baseline (12.7 ± 1.4 vs. 11.9 ± 1.6 ml/kg/min respectively; p<.05), but no improvements were seen in the controls. There were significant decreases in systolic blood pressure post-nutrition intervention when compared to baseline (123.7 ± 17.3 vs. 134.4 ± 19.1mmHg respectively, p<.05), but values showed a non-significant increase again post-exercise intervention (133.1 ± 17.4mmHg). There was a significant interaction effect (p=.01) between groups for small artery compliance post-intervention compared to baseline, with the experimental group improving when compared to baseline (4.6 ± 2.4 vs. 3.5 ± 1.6mL/mmHg, respectively) and the control group showing a decline (3.1 ± 1.2 vs. 4.3 ± 2.4mL/mmHg, respectively). Large artery compliance showed a non-significant interaction effect (p=.08) with small increases in the experimental group when compared to baseline (13.1 ± 3.9 vs. 11.4 ± 2.5mL/mmHg, respectively) and small decreases in the control group when compared to baseline (10.4 ± 2.8 vs. 11.1 ± 3.2, respectively). No significant differences were seen in either time-domain or frequency-domain measures of HRV. A comprehensive nutrition and exercise intervention appears to improve vascular health and aerobic fitness, with trends in improvement for BMI, muscular strength, and flexibility.Medicine, Faculty ofMedicine, Department ofExperimental Medicine, Division ofGraduat