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ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #162016
Title: RESISTANCE TRAINING TO REDUCE THE MALNUTRITION-INFLAMMATION COMPLEX SYNDROME OF CHRONIC KIDNEY DISEASE

Author
item CASTANEDA-SCEPPA, CARMEN - TUFTS-HNRCA
item GORDON, PATRICIA - VETERANS AFFAIR MED CTR
item PARKER, RUSSELL - TUFTS-HNRCA
item UHLIN, KATHERINE - TUFTS-HNRCA
item ROUBENOFF, RONENN - MILLENNIUM PHARM INC
item LEVEY, ANDREW - TUFTS-NEMC

Submitted to: American Journal of Kidney Diseases
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/18/2003
Publication Date: 4/1/2004
Citation: CASTANEDA-SCEPPA, C., GORDON, P.L., PARKER, R.C., UHLIN, K.L., ROUBENOFF, R., LEVEY, A.S. RESISTANCE TRAINING TO REDUCE THE MALNUTRITION-INFLAMMATION COMPLEX SYNDROME OF CHRONIC KIDNEY DISEASE. AMERICAN JOURNAL OF KIDNEY DISEASES. 2004;43(4):607-616.

Interpretive Summary: The combined occurrence of protein-energy malnutrition and inflammation in kidney failure, referred to as the Malnutrition-Inflammation Complex Syndrome, may be associated with poor outcomes such as cardiovascular atherosclerotic disease, decreased quality of life, increased mortality and hospitalization. The purpose of the present study was to characterize whether the anabolic stimulus of resistance training would lead to reduction in systemic inflammation as measured by serum C-reactive protein (CRP) and interleukin-6 (IL-6 levels). In addition, we were interested in determining the association between inflammatory markers and nutritional and functional parameters. This study showed that individuals with moderately severe chronic kidney disease, consuming a low protein diet and undergoing resistance training for 12 weeks, exhibited a reduction in systemic inflammation characterized by declines in serum CRP and IL-6 levels. A concomitant increase in serum albumin and transferrin concentrations was observed. Muscle hypertrophy and strength also improved significantly with resistance training. The observed reduction in inflammatory mediators was significantly associated with improved nutritional status and functional capacity. The findings of this study suggest that resistance training may reverse the malnutrition-inflammation complex syndrome of chronic kidney disease implicated in the poor prognosis of individuals with kidney disease. Although maintenance dialysis and kidney transplantation promote extended survival in kidney failure, these therapies may be less effective in improving nutritional status and quality of life. Therefore, long-term interventions of resistance training should be investigated further as novel therapeutic approaches for this patient population are being considered.

Technical Abstract: Systemic inflammation and protein-energy malnutrition may be associated with poor outcomes in kidney disease. We studied 26 adults (65 +/- 10 y [SD]) with chronic kidney disease, not on dialysis. Subjects were randomized to resistance training (n=14) or a control group (n=12) for 12 weeks, while counseled to consume a low protein diet (~0.6 g/kg/day). We determined whether resistance training reduces the inflammatory mediators (serum C-reactive protein [CRP] and interleukin-6 [IL-6]), in addition to the previously reported improvements in nutritional and functional status in this same subject population. Serum CRP levels were reduced in subjects undergoing resistance training (-1.7 mg/L) compared to controls (1.5 mg/L, P=0.05). Similarly, IL-6 levels were reduced in the resistance exercise group vs. controls (-4.2 vs. 2.3 pg/mL, P=0.01). Resistance training lead to skeletal muscle hypertrophy, as shown by increases in type I (24 +/- 31%) and type II (22 +/- 41%) muscle fiber cross-sectional areas, compared to control subjects (-14 +/- 34% and -13 +/- 18%, respectively, P<0.05). Muscle strength also improved with resistance training (28 +/- 14%) compared to controls (-13 +/- 22%, P=0.001). Resistance training reduced inflammation and improved nutritional status in individuals with moderate chronic kidney disease consuming a low protein diet. These results need to be investigated further in larger cohorts of patients with varying stages of kidney disease, to determine whether resistance training can improve disease outcomes long-term.