Efeito do exercício aeróbico sobre marcadores séricos do metabolismo mineral e ósseo de pacientes com doença renal crônica e excesso de peso na fase não dialítica

• Ano de defesa: 2016
• Autor(a) principal: Gomes, Tarcisio Santana [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Aerobic exercise; Bone metabolism; Chronic kidney disease; Overweight patients; Doença renal crônica; Obesidade; Exercício físico; Metabolismo ósseo
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4630400; https://repositorio.unifesp.br/handle/11600/46173

Introduction: Chronic kidney disease (CKD) is currently considered a public health problem. Obesity, condition commonly observed in this population, has been identified as an independent risk factor for the development and progression of CKD. Studies show the prevalence of obesity is increasing in parallel with the growing incidence of CKD. Hormonal and metabolic changes due CKD, including hyperphosphatemia, hypocalcemia, increased secretion of parathyroid hormone (PTH) and fibroblast growth factor (FGF-23) and reduced renal synthesis of calcitriol (1,25 (OH)2D) are the main factors responsible for the development of mineral and bone disorder of CKD (CKD-MBD), which is a broad clinical syndrome that includes bone mineral calcification and cardiovascular disorders. The association of CKD and obesity may promote changes in bone, contributing for worsening the quality of life of these patients. Studies show that physical exercise improves several aspects of physical and functional capacity of patients with CKD. However, the impact of exercise on bone metabolism in these patients has been poorly investigated. Recently, serum markers of bone metabolism have been identified and used to detect the dynamics of bone metabolism in response to exercise. Objective: To investigate the effect of aerobic exercise training on bone metabolism markers in overweight patients with non-dialysis-dependent CKD (NDD-CKD). Methods: This is a prospective, longitudinal study with post hoc analysis. The study was randomized and controlled aimed to compare the effect of home-based aerobic exercise (walking) and performed in a specialized center on cardiorespiratory and functional parameters of patients with CKD and overweight. We studied 39 sedentary patients (69% male) who were on stage 3 or 4 of CKD, aged 55.5±8.3 years (mean ± SD), BMI 31.2±4,4 kg / m2 and estimated glomerular filtration rate (eGFR) of 26.9±11.7 mL / min / 1.73m2 who were randomly assigned to the aerobic exercise group (n = 24) or the control group (n = 15). Patients were tested for cardiorespiratory fitness, functional capacity and routine laboratory tests before and after 24 weeks of follow-up. Training program was conducted in accordance with the VO2peak patients. Traditional markers of bone and mineral metabolism such as PTH, calcium, phosphorus and total alkaline phosphatase, were analyzed. Carboxylated osteocalcin (GLA), undercarboxylated osteocalcin (GLU), sclerostin, tartrate-resistant acid phosphatase isoform 5b (TRAP 5b) from serum stored at -80 °C. were determined by enzyme-linked immunosorbent assay (ELISA) according to the specifications of the suppliers. Results: At baseline there were no differences between the groups regarding demographic, clinical, physical and functional capacity, body composition and bone metabolism markers. At baseline, GLA and GLU were inversely correlated with eGFR. Both osteocalcin fragments were positively correlated with total alkaline phosphatase. An inverse correlation was found between GLA and sclerostin with body fat. In contrast, GLU was negatively correlated with markers of muscle mass. TRAP-5b and sclerostin were inversely correlated with 6-min walk test and time up and go test, respectively. The VO2peak, marker of cardiorespiratory capacity is not related to any of the bone metabolism markers analyzed. In both groups, eGFR, body weight and body composition parameters did not change during the study. After 24 weeks all physical capacity parameters increased in the exercise group (p < 0.001). Except for total alkaline phosphatase that increased after 24 weeks in the exercise group (p < 0.05), no other changes were observed in both groups in relation to the bone metabolism markers investigated. Conclusion: Our study showed that the proposed aerobic training did not promote relevant changes in the bone metabolism markers studied despite the improvement in physical capacity of patients.