Effects of different exercises on renal and cardiovascular function in adult patients with chronic kidney disease not receiving dialysis: a network meta-analysis

We conducted a network meta-analysis of randomized trials to assess the effect of different exercises on the renal and cardiovascular function of patients with chronic kidney disease not receiving dialysis. The PubMed, Embase, Web of science, COCHRANE LIBRARY, Trials, CNKI, WANFANG DATA and VIP were searched. The standardized mean difference (SMD), with a 95% confidence interval (CI), for outcomes were summarized. A random effects model was used across all comparisons. Surface under the cumulative ranking curve (SUCRA) and mean ranks were reported to evaluate the treatment hierarchy. A total of 49studies were included. Regarding renal function, resistance exercise (RE), RE + blood flow restriction (BFR), and aerobic exercise (AE) significantly improved eGFR compared to the control group, except for AE + RE; and just AE could significantly improve SCR (serum creatinine). Regarding cardiovascular function, compared with the control group, RE + BFR, RE, and AE significantly reduced systolic blood pressure (SBP) and diastolic blood pressure (DBP); AE and AE + RE were suitable for improving the VO2peak. However, no significant differences were found in pulse wave velocity (PWV), TC, TG, LDL, or HDL levels between any of the groups when compared pairwise. Furthermore, RE significantly reduced CRP, and AE + RE significantly reduced BMI compared with the control group. According to SUCRA, RE + BFR, followed by RE appeared to yield relatively greater improvements in eGFR and blood pressure. The results of this study indicate that different physical exercises can improve renal and cardiovascular functions to various extents, and patients are advised to perform personalized physical exercises in order to achieve to specific outcomes.