P138
SYSTEMIC INFLAMMATION IN CHRONIC KIDNEY DISEASE: EFFECT OF
ACUTE AND REGULAR MODERATE INTENSITY AEROBIC EXERCISE
Viana, J, 1, Bishop, N1, Kosmadakis, G2, Bevington, A3, Clapp, E1, Feehally, J2, Smith, A2
1
School of Sport, Exercise and Health Sciences, Loughborough University; 2John Walls
Renal Unit, Leicester General Hospital; 3Department of Infection, Immunity and
Inflammation, University of Leicester
Chronic kidney disease (CKD) is associated with chronic systemic inflammation. Regular
exercise has been shown to exert anti-inflammatory effects in various chronic disease states, but
to date, the influence of exercise on inflammatory status in CKD is unclear. The aim of this
study was to investigate the effects of acute and 1 month of regular moderate intensity aerobic
exercise on systemic inflammation markers in CKD patients.
Eighteen CKD (stage 4 and 5 pre-dialysis) patients (14M and 4F), mean age 58 years (range 3873 years), exercised for 30 min, 5 times per week, for 1 month. The exercise programme
consisted of brisk walking at a Rating of Perceived Exertion (RPE) in the range of 12-14. At
baseline and after the 1-month training period patients performed a standard 30 min treadmill
exercise test. Venous blood samples were collected before (Pre), immediately after (Post) and 1
h after (1H) the baseline exercise test and before the 1-month exercise test. Plasma interleukin10 (IL-10; an anti-inflammatory cytokine), and interleukin-6 (IL-6), C-reactive protein (CRP)
and soluble tumor necrosis factor receptors I and II (sTNF-RI and sTNF-RII) (all proinflammatory) were measured by ELISA.
Acute exercise induced a transient increase in plasma IL-6 (Post: 8.5 ±1.2 vs. Pre: 7.5 ±1.1
pg/ml, P=0.006; 1H: 8.0 ±1.1 pg/ml, P=0.268 vs. Pre) and a sustained increase in plasma IL-10
(Post: 4.7 ±0.8 vs. Pre: 3.7 ±0.6 pg/ml, P=0.010; 1H: 5.8 ±1.3 pg/ml, P=0.029 vs. Pre), but had
little effect on the other markers studied.
Average RPE response to the exercise test after the training period was lower than at baseline
(11 ±0 vs. 13 ±0, P<0.001). At this time, plasma levels of IL-6 (5.8 ±0.6 vs. 7.5 ±1.1 pg/ml,
P=0.048), sTNF-RI (5.6 ±0.5 vs. 6.3 ±0.5 ng/ml, P=0.002) and sTNF-RII (13.6 ±1.4 vs. 15.5
±1.1 ng/ml, P=0.028) were reduced, while plasma IL-10 levels were increased (4.6 ±0.6 vs. 3.7
±0.6 pg/ml, P=0.044). Plasma CRP concentration remained unchanged (3.4 ±1.0 vs. 4.3 ±1.5
µg/ml, P=0.300). Exercise training exerted the greatest anti-inflammatory effect in those
patients with the highest plasma IL-6 at baseline.
CKD is associated with extremely high cardiovascular risk, and markers of systemic
inflammation have been shown to correlate with cardiovascular outcome. We found that regular
moderate aerobic exercise decreased plasma levels of pro-inflammatory IL-6 and TNF-Rs and
increased anti-inflammatory IL-10. These effects were most marked in patients with evidence of
significant systemic inflammation, and indicate that participation in a regular exercise
programme may reduce cardiovascular risk in these vulnerable patients.