Document Type : Original Article
Authors
1 Department of Toxicology and Pharmacology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
2 Pharmaceutical Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran & Department of Toxicology and Pharmacology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
3 Department of Internal Medicine, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
4 Physiology Research Center, Endocrinology and Metabolism Research Center, Kerman University of Medical Sciences, Kerman, Iran
Abstract
Background: Oxidative stress (OS) and inflammation are common factors in patients with chronic kidney disease and increase the risk of cardiovascular disease (CVD) and death in these patients, particularly in hemodialysis (HD) cases. Exercise training is a therapeutic approach to reduce morbidity and mortality in these patients. The purpose of this study was to determine the effect of aerobic exercise training on OS factors in HD patients.
Methods: This case-control study was performed over one year (From March 2019 to February 2020) at Kerman (south of Iran). Nineteen outpatient HD patients participated in an aerobic exercise training program during HD. Cycling was performed by mini-cycle in the first hour of HD, pedaling was started with the least tolerable time by the patients, and increased up to three-quarters of an hour based on the patient’s tolerance, three times a week for eight weeks. Also control group, 18 outpatient HD patients were selected and did not enter the exercise training program. Blood samples were collected before and after the intervention in both groups. Inflammatory factors such as albumin (Alb), C-reactive protein (CRP), ferritin, white blood cell (WBC) as well as, oxidative and nitrogenous factors such as malondialdehyde (MDA), carbonyl groups, uric acid, and ionic regenerating capacity were measured. Chi-square and independent t test were used to analyze the data and compare the two groups.
Results: There were no significant differences in CRP, Alb, and uric acid between the two groups. In the test group, variables such as total antioxidant capacity (TAC), glutathione (GSH), protein carbonyl (PC), lipid peroxidation (LPO) products, ferric reducing ability of plasma (FRAP), and thiobarbituric acid reactive substances (TBARST) showed a significant difference after the intervention. The values of TAC, GSH, and FRAP in the case group were significantly higher than the same values in the control group (P ≤ 0.0001 for all), but PC (P ≤ 0.006) and TBARS (P ≤ 0.026) values were higher in the control group after the intervention. The intervention had no effect on Alb and ferritin. But, uric acid levels decreased significantly in both groups after the intervention. In the case group, TAC, GSH, and FRAP increased (P = 0.0001 for all), but PC, LPO, and TBARST decreased (P = 0.0001, P ≤ 0.03, and P ≤ 0.02 respectively).
Conclusion: The results of the present study showed that aerobic exercise training had no effect on inflammatory factors such as CRP, ferritin, and Alb.
Keywords
M, et al. Impact of chronic renal failure on surgical outcomes
in patients with infective endocarditis. Ann Thorac Surg.
2021;111(3):828-35. doi: 10.1016/j.athoracsur.2020.06.023.
2. Sharma P, Fenton A, Dias IHK, Heaton B, Brown CLR, Sidhu
A, et al. Oxidative stress links periodontal inflammation and
renal function. J Clin Periodontol. 2021;48(3):357-67. doi:
10.1111/jcpe.13414.
3. Brown JH, Hunt LP, Vites NP, Short CD, Gokal R, Mallick
NP. Comparative mortality from cardiovascular disease in
patients with chronic renal failure. Nephrol Dial Transplant.
1994;9(8):1136-42. doi: 10.1093/ndt/9.8.1136.
4. Maggi E, Bellazzi R, Falaschi F, Frattoni A, Perani G, Finardi
G, et al. Enhanced LDL oxidation in uremic patients: an
additional mechanism for accelerated atherosclerosis? Kidney
Int. 1994;45(3):876-83. doi: 10.1038/ki.1994.115.
5. Guo J, Yang G, He Y, Xu H, Fan H, An J, et al. Involvement
of α7nAChR in the protective effects of genistein against
β-amyloid-induced oxidative stress in neurons via a PI3K/
Akt/Nrf2 pathway-related mechanism. Cell Mol Neurobiol.
2021;41(2):377-93. doi: 10.1007/s10571-020-01009-8.
6. Lorenzon Dos Santos J, de Quadros AS, Weschenfelder C,
Garofallo SB, Marcadenti A. Oxidative stress biomarkers, nutrelated
antioxidants, and cardiovascular disease. Nutrients.
2020;12(3):682. doi: 10.3390/nu12030682.
7. Marina R, González P, Ferreras MC, Costilla S, Barrio
JP. Hepatic Nrf2 expression is altered by quercetin
supplementation in X-irradiated rats. Mol Med Rep.
2015;11(1):539-46. doi: 10.3892/mmr.2014.2741.
8. Ekun OA, Daniel F, Adebola P, Ajibare A, Ekun OO,
Omogoroye OO, et al. Assessment of plasma sodium to
potassium ratio, renal function, markers of oxidative stress,
inflammation, and endothelial dysfunction in Nigerian
hypertensive patients. Int J Hypertens. 2020;2020:6365947.
doi: 10.1155/2020/6365947.
9. Marnett LJ. Lipid peroxidation-DNA damage by
malondialdehyde. Mutat Res. 1999;424(1-2):83-95. doi:
10.1016/s0027-5107(99)00010-x.
10. Liakopoulos V, Roumeliotis S, Gorny X, Dounousi E, Mertens
PR. Oxidative stress in hemodialysis patients: a review of the
literature. Oxid Med Cell Longev. 2017;2017:3081856. doi:
10.1155/2017/3081856.
11. Rahmani A, Maleki V, Niknafs B, Tavakoli-Rouzbehani OM,
Tarighat-Esfanjani A. Effect of Nigella sativa supplementation
on kidney function, glycemic control, oxidative stress,
inflammation, quality of life, and depression in diabetic
hemodialysis patients: study protocol for a double-blind,
randomized controlled trial. Trials. 2022;23(1):111. doi:
10.1186/s13063-021-05917-y.
12. Mohseni R, Emami Zeydi A, Ilali E, Adib-Hajbaghery M,
Makhlough A. The effect of intradialytic aerobic exercise
on dialysis efficacy in hemodialysis patients: a randomized
controlled trial. Oman Med J. 2013;28(5):345-9. doi:
10.5001/omj.2013.99.
13. Teixeira-Lemos E, Nunes S, Teixeira F, Reis F. Regular
physical exercise training assists in preventing type 2
diabetes development: focus on its antioxidant and antiinflammatory
properties. Cardiovasc Diabetol. 2011;10:12.
doi: 10.1186/1475-2840-10-12.
14. Nolte K, Herrmann-Lingen C, Wachter R, Gelbrich G, Düngen
HD, Duvinage A, et al. Effects of exercise training on different
quality of life dimensions in heart failure with preserved
ejection fraction: the Ex-DHF-P trial. Eur J Prev Cardiol.
2015;22(5):582-93. doi: 10.1177/2047487314526071.
15. Afshar R, Shegarfy L, Shavandi N, Sanavi S. Effects of
aerobic exercise and resistance training on lipid profiles and
inflammation status in patients on maintenance hemodialysis.
Indian J Nephrol. 2010;20(4):185-9. doi: 10.4103/0971-
4065.73442.
16. Mohkam M. Yoga as a therapeutic intervention in patients with
chronic kidney diseases. J Pediatr Nephrol. 2014;2(4):129-31.
17. Wilund KR, Tomayko EJ, Wu PT, Ryong Chung H, Vallurupalli
Ghoraba et al
558 Journal of Kerman University of Medical Sciences. Volume 29, Number 6, 2022
S, Lakshminarayanan B, et al. Intradialytic exercise training
reduces oxidative stress and epicardial fat: a pilot study.
Nephrol Dial Transplant. 2010;25(8):2695-701. doi: 10.1093/
ndt/gfq106.
18. Torres E, Aragoncillo I, Moreno J, Vega A, Abad S, García-
Prieto A, et al. Exercise training during hemodialysis sessions:
physical and biochemical benefits. Ther Apher Dial.
2020;24(6):648-54. doi: 10.1111/1744-9987.13469.
19. Gordon L, McGrowder DA, Pena YT, Cabrera E, Lawrence-
Wright MB. Effect of yoga exercise therapy on oxidative stress
indicators with end-stage renal disease on hemodialysis. Int J
Yoga. 2013;6(1):31-8. doi: 10.4103/0973-6131.105944.
20. Esgalhado M, Stockler-Pinto MB, de França Cardozo LF, Costa
C, Barboza JE, Mafra D. Effect of acute intradialytic strength
physical exercise on oxidative stress and inflammatory
responses in hemodialysis patients. Kidney Res Clin Pract.
2015;34(1):35-40. doi: 10.1016/j.krcp.2015.02.004.
)