Effects Of Resistance Exercise On Physical Performance In Chronic Kidney Disease Patients: A Meta-Analysis

Chronic Kidney Disease (CKD) is a major global health concern, affecting approximately one in seven adults in the United States. A notable problem in patients with CKD is decreased muscle mass, which leads to increased morbidity and mortality. In addition, inflammatory markers are significant in predicting mortality in CKD patients, and high level of these markers are associated with increased risks and mortality in CKD patients. PURPOSE: To determine the effects of resistance exercise on physical performance and inflammatory markers in patients with CKD. METHODS: We included randomized controlled trials, which examined the effects of resistance exercise on muscle mass, strength and inflammatory markers in patients with CKD. (Stage 2-5). We searched of PubMed, Embase from December 2001 to April 2023. We assessed possible bias and applicability of the studies using the RoB2 tool. The effect size, calculated as the difference in outcome improvement between groups, utilized standardized mean difference (SMD) and a 95% confidence interval. Heterogeneity was addressed by examining outlier studies, qualitatively exploring divergent results, and conducting sensitivity analyses on study exclusions. RESULTS: A total of 20 studies were included in the meta-analysis. The results indicate a significant increase in muscle strength [SMD 1.25 (95% CI: 0.78, 1.73); n = 15] and muscle mass [SMD 0.43 (95% CI: 0.04, 0.82); n = 14] within the intervention group compared to the control group. Resistance exercise significantly improved IL-6 [SMD -0.54 (95% CI: -1.06, -0.03); n = 6] and TNF-α levels [SMD -1.80 (95% CI: -3.19, -0.41); n = 4] compared to the control condition. However, no statistical significance was found for CRP [SMD -0.51(95% CI: -1.03, 0.02); n = 7]. LIMITATION: The included studies manifest heterogeneity, potentially limiting the generalizability of findings due to a scarcity of available data. CONCLUSION: Resistance exercise shows promise in improving muscle strength, increasing muscle mass, and positively affecting inflammatory markers in individuals with CKD. REGISTRATION: This study was registered with PROSPERO (CRD42023462463) The Yonsei Signature Research Cluster Project (2023-22-0009)