Effects of chronic kidney disease and exercise training on the blood pressure response to exercise

Individuals with chronic kidney disease (CKD) are at high risk for cardiovascular disease and events. Higher resting blood pressure (BP), lower exercise capacity, and an exaggerated BP response to exercise are commonly observed in CKD. The slope of systolic BP (SBP) and workload are independent of resting BP, predictive of cardiovascular events, and may provide additional information in CKD. Exercise training is routinely recommended to reduce blood pressure but whether it is effective in altering the slope of SBP and workload in CKD has not been investigated. Purpose: We sought to determine the slope of SBP and workload in individuals with CKD at baseline and following either 12 weeks of exercise or a control condition. Additionally, we assessed the slope of SBP and workload in a group of healthy control subjects. Hypothesis: We hypothesized that individuals with CKD would exhibit a steeper rise in BP during exercise compared to healthy individuals, and that exercise training would reduce the slope of SBP and workload in CKD. Methods: BP was recorded during graded exercise testing (GXT) performed on a cycle ergometer in 17 individuals with CKD (mean age= 61±11 years, mean eGFR=46±13 ml/min/1.73m 2 ) and 19 healthy controls (mean age= 57±5 years, eGFR >60 ml/min/1.73m 2 ). The CKD group was randomly assigned to an exercise training (EX; n=9) or a control (CON, n=8) group. EX consisted of 12 weeks of supervised aerobic exercise 3 times per week. Exercise duration and intensity progressively increased to 45 minutes at 65% to 85% heart rate reserve. CON received routine care. Both groups repeated exercise testing following 12 weeks. BP at rest, two submaximal intensities, and peak intensity were utilized to calculate slopes. Nonlinear SBP responses were excluded from slope analyses. Results: Healthy individuals achieved a higher workload (167±43 W) compared to individuals with CKD (135±49 W, p=.043). Resting (138±22 mmHg vs. 123±14 mmHg, p=.018) and maximal SBP (210±29 mmHg vs. 192±22 mmHg, p=.032) were higher in the CKD group than in the healthy group. During the GXT, the CKD group demonstrated a steeper slope of SBP and workload than the healthy group (0.63±0.15 vs. 0.45±0.13, p=.031). There were no differences in peak BP or the slope of SBP and workload following 12 weeks of EX or CON. Conclusion: These data suggest that individuals with CKD experience elevated SBP at rest and at peak exercise intensities, along with a steeper increase in SBP during exercise. While 12 weeks of exercise training did not alter the BP response to exercise in our small sample of individuals with CKD, further investigation is warranted. Funding source: National Institutes of Health, National Heart Lung and Blood Institute grant R01HL113514 This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.