Background:
The incidence of End Stage Renal Disease (ESRD) has increased in recent years. Hypertension is a well described complication of chronic kidney disease. Its incidence in hemodialysis patients is approximately 80% and there is substantial evidence of the relationship between high blood pressure and cardiovascular risk in this population.
Objective:
To systematically review the effects of physical exercise on blood pressure of patients with ESRD undergoing hemodialysis (HD).
METHODS:
MEDLINE, EMBASE, COCHRANE CENTRAL and LILACS databases were searched for trials published between January 1980 and August 2011. Only randomized clinical trials (RCTs) with adult patients diagnosed with ESRD on HD comparing aerobic exercise, resistance training or combined resistance and aerobic training with the control group were eligible. The selection of studies, data extraction and assessment of methodological quality were performed by two independent reviewers. The meta-analysis was conducted using the random effects model.
Results:
Our search found 1.034 articles, from which 12 RCTs (389 participants) met the eligibility criteria and were included. We observed that combined resistance and aerobic training (six RCTs) reduces the systolic (-5.84 mmHg; 95% CI: -9.8, -1.88) and the diastolic blood pressure (-3.90 mmHg; 95% CI: -6.20, -1.60); however, the same was not observed with aerobic exercise (six RCTs) (SBP: -0.84 mmHg, 95% CI: -7.18, 5.51 and DBP: 0.68 mmHg, 95% CI: -3.38, 4.74). Probably, the absence of blood pressure decrease with aerobic exercise was due to the small sample size of those studies, the inclusion of both hypertensive and non hypertensive patients and the lack of information whether there was a control of the dosage of antihypertensive medication during follow-up.
Conclusions:
Combined resistance and aerobic training reduces the blood pressure of ESRD patients on HD and, therefore, can be recommended as an adjuvant non-pharmacological intervention in the treatment of ESRD patients on HD. Sources of Funding: Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
4118A meta-analysis on standard and intensive blood pressure control in patients with chronic kidney disease
