Metabolic and functional effects of exercise training in diabetic kidney transplant recipients

Table 1 Patients’ baseline demographic and clinical data

	Exercise group	Control group	P value
Sex (male/female)	8/3	8/2	0.52
Age (yr)	52.9 ± 9.5	53.0 ± 13.1	0.51
Height (cm)	1.6 ± 0.5	1.6 ± 0.0	0.34
Weight (kg)	70.8 ± 12.2	72.1 ± 6.7	0.77
BMI (kg/m2)	24.4 ± 2.6	25.6 ± 2.0	0.23
Place of residence
Rural area	27.2% (3/11)	40.0% (4/10)	0.69
Urban area	72.7% (8/11)	60.0% (6/10)	0.42
Education
Primary education	54.5% (6/11)	40.0% (4/10)	0.33
Secondary education	18.1% (2/11)	10.0% (1/10)	0.68
Higher education	9.0% (1/11)	20.0% (2/10)	0.65
No education	18.1% (2/11)	30.0% (3/10)	0.70
Employment status
Employed	18.1% (2/11)	10.0% (1/10)	0.71
Unemployed	54.5% (6/11)	40.0% (4/10)	0.53
Retired	27.2% (3/11)	50.0% (5/10)	0.38
Smoking	18.1% (2/11)	10.0% (1/10)	0.74
eGFR-CKD-EPI equation (mL/min)	61.0 ± 7.3	59.5 ± 8.2	0.53
Stage of diabetic nephropathy
Stage 3	81.8% (9/11)	90.0% (9/10)	0.77
Stage 4	18.1% (2/11)	10.0% (1/10)	0.64
Time after KTx (mo)	47.4 ± 18.3	47.8 ± 18.1	0.68
Primary causes of ESKD
Diabetes mellitus	54.5% (6/11)	50.0% (5/10)	0.64
Hypertension	27.2% (3/11)	20.0% (2/10)	0.56
Polycystic kidney disease	18.1% (2/11)	10.0% (1/10)	0.56
Glomerulonephritis	9.0% (1/11)	10.0% (1/10)	0.72
Nephrosclerosis	9.0% (1/11)	0.0% (0/10)	0.55
Reflux nephropathy	0.0% (0/11)	10.0% (1/10)	0.61
Others	0.0% (0/11)	10.0% (1/10)	0.59
Medication
Statins	100.0% (11/11)	100.0% (10/10)	0.53
Calcium channel blockers	36.3% (4/11)	50.0% (5/10)	0.23
Oral antidiabetic drugs	18.1% (2/11)	30.0% (3/10)	0.51
Angiotensin II receptor blockers/angiotensin converting enzyme blockers	54.5% (6/11)	50.0% (5/10)	0.66
Slow and/or intermediate acting insulin	81.9% (9/11)	70.0% (7/10)	0.47
Immunosuppression therapy (corticosteroid, tacrolimus, mycophenolate mofetil)	100.0% (11/11)	100.0% (10/10)	0.74
Adherence to medication	90.9% (10/11)	100.0% (10/10)	0.82
Hematocrit (%)	42.1 ± 4.6	39.8 ± 4.5	0.63
Hemoglobin (g/dL)	14.1 ± 1.0	13.1 ± 1.6	0.16
Na+ (mg/dL)	139.8 ± 2.5	140.3 ± 4.3	0.90
K+ (mg/dL)	4.1 ± 0.3	4.3 ± 0.5	0.15
Ca2+ (mg/dL)	10.1 ± 0.5	9.7 ± 0.9	0.94
P (mg/dL)	2.9 ± 0.5	3.4 ± 0.4	0.09
Mg+ (mg/dL)	1.6 ± 0.1	1.6 ± 0.3	0.50
Fe+ (mg/dL)	89.8 ± 23.2	87.9 ± 16.6	0.54
Urea (mg/dL)	42.2 ± 8.7	48.1 ± 16.7	0.90
Creatinine (mg/dL)	1.1 ± 0.2	1.2 ± 0.5	0.16
Alkaline phosphatase (mg/dL)	72.1 ± 27.2	62.5 ± 10.4	0.17
Uric acid (mg/dL)	5.7 ± 1.1	5.9 ± 1.2	0.23
24-h urine albumin level (mg/dL)	106.4 ± 25.1	115.6 ± 20.9	0.25

Paired-sample t-test for continuous variables. Significant at the 0.05 level (P < 0.05). BMI: Body mass index; KTx: Kidney transplantation; eGFR: Estimated glomerular filtration rate; ESKD: End-stage kidney disease; CKD-EPI: Chronic kidney disease epidemiology collaboration equation; Na: Sodium; P: Potassium; Ca: Calcium; Mg: Magnesium; P: Phosphorus; Fe: Iron.

Table 2 Lipid and glucose profile at the beginning and the end of the 6-mo clinical trial

	Exercise group			Control group			Exercise vs control group
	Baseline	After 6-mo	P value	Baseline	After 6-mo	P value	Pre	Post
FPG (mg/dL)	120.6 ± 28.9	104.8 ± 21.9	0.01	116.1 ± 33.2	115.4 ± 33.9	0.38	0.47	< 0.05
TC (mg/dL)	224.8 ± 30.4	224.0 ± 30.1	0.11	229.7 ± 28.8	230.8 ± 27.8	0.60	0.41	0.48
TG (mg/dL)	164.7 ± 14.8	150.8 ± 11.6	< 0.05	165.4 ± 19.0	165.2 ± 20.5	0.67	0.11	0.04
HDL (mg/dL)	51.4 ± 8.8	57.2 ± 8.7	< 0.05	51.1 ± 7.9	51.3 ± 12.6	0.43	0.56	0.06
LDL (mg/dL)	119.6 ± 11.4	119.4 ± 10.9	0.27	119.4 ± 17.0	119.5 ± 16.4	0.33	0.78	0.45
HbA1c (%)	6.7 ± 0.4	6.6 ± 0.4	0.01	6.5 ± 1.0	6.5 ± 1.1	0.25	0.20	0.36

Data are expressed as mean ± SD. P > 0.05: Baseline vs 6 mo follow-up; P > 0.05 and P < 0.05: Exercise vs control group. FPG: Fasting plasma glucose; TC: Total cholesterol; TG: Triglycerides; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; HbA1c: Hemoglobin A1c.

Table 3 Functional capacity and respiratory responses at the beginning and the end of the 6-mo clinical trial

	Exercise group			Control group			Exercise vs control group
	Baseline	After 6-mo	P value	Baseline	After 6-mo	P value	Pre	Post
(VO2)peak (mL/kg/min)	22.7 ± 3.3	23.8 ± 4.2	0.02	21.9 ± 4.1	21.8 ± 3.2	0.34	0.43	0.01
RERmax	1.1 ± 0.0	1.2 ± 0.1	0.53	1.1 ± 0.0	1.1 ± 0.2	0.75	0.73	0.48
VO2/HRmax	12.6 ± 3.3	13.0 ± 3.0	0.23	12.7 ± 2.9	12.8 ± 2.6	0.69	0.63	0.51
VE/(VO2)max	37.2 ± 5.0	36.3 ± 2.2	0.54	37.4 ± 4.8	37.3 ± 4.5	0.56	0.54	0.62
VE/V(CO2)max	33.0 ± 4.4	32.4 ± 4.3	0.60	32.9 ± 4.1	33.2 ± 3.8	0.33	0.38	0.43

Data are expressed as mean ± SD. P > 0.05: Baseline vs 6 mo follow-up; P > 0.05 and P < 0.05: Exercise vs control group. HR: Heart rate; RER: Respiratory exchange ratio; VO₂/HR_max: Ratio between VO₂ and maximum heart rate; VE: Pulmonary ventilation; VE/(VO₂)_max: Ventilatory equivalents for oxygen; VE/V(CO₂)_max: Ventilatory equivalents for carbon dioxide; (VO₂)_peak: Maximum oxygen consumption.