Comparative efficacy of different modes of exercise on inflammatory markers in patients with chronic kidney disease: a systematic review with pairwise and network meta-analyses

This systematic review with pairwise and network meta-analyses aimed to evalute the effects of different modes of exercise on improving inflammation in patients with chronic kidney disease (CKD). A comprehensive search was conducted in the PubMed, Scopus, Web of Science, and Embase from inception to February 2025. Randomized trials investigating the effects of different exercise modes on interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor (TNF-α), or C-reactive protein (CRP) in patients with CKD were included. A total of 37 randomized trials, including 1,930 participants were included. All exercise modes reduced IL-6, TNF-α, and CRP, and increased IL-10 significantly more than control (CON). As compared with the CON, resistance training resulted in larger reductions in IL-6, TNF-α, and CRP, and larger increases in IL-10. Aerobic training led to larger reductions in IL-6 and TNF-α, but no significant effects were observed on IL-10 and CRP. Combined training did not significantly affect any inflammatory markers. A range of exercise modes is effective for improving markers of inflammation in patients with CKD, and resistance training may be more beneficial as compared with aerobic and combined training for anti-inflammatory effect. However, further high-quality randomized trials are needed to fully elucidate the anti-inflammatory potential of exercise.