OBJECTIVES Patients with chronic kidney disease (CKD) are at a high risk of future autonomic dysfunction and cardiovascular disease. The aim of this study was to examine the effects of a 12-month lifestyle intervention (LI) involving regular aerobic exercise on cardiac autonomic function in CKD patients. DESIGN Pooled exploratory analysis. METHODS 113 eligible patients with stage 3-4 CKD (eGFR 25-60 ml/min/1.75m2) participated in a LI program, including an 8-week individualised gym-based exercise program followed by a 10-month home-based program. The control (CON) group underwent standard nephrological care. The following parameters were assessed prior to and following the 12-month study period: cardiorespiratory fitness (VO2peak) from a graded exercise test; cardiac autonomic function from time, frequency, and non-linear measures of heart rate variability (HRV), heart rate (HR) recovery following peak exercise, and chronotropic competence during exercise. RESULTS Compared to the CON group, the LI group significantly increased VO2peak (CON = -1.0 vs. LI = +1.8 ml/kg/min, p < 0.01) while there was no significant improvement in any HRV measure (p = 0.85), HR recovery (p = 0.38) or chronotropic competence (p = 0.28). Changes in relative VO2peak were significantly associated with changes in a non-linear HRV measure, α1 (p < 0.01), independent of age and eGFR (r2 = 0.196, p = 0.03). CONCLUSIONS Despite the significant increase in cardiorespiratory fitness for the LI group, there were no changes in cardiac autonomic function. However, α1 may be a sensitive measure to assess VO2peak changes in this clinical cohort. Further research is required to investigate the role of different modalities of exercise training to enhance cardiac autonomic function in patients with CKD.

中文翻译：

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一项为期 12 个月的生活方式干预并未改善慢性肾病患者的心脏自主神经功能

目的 慢性肾病 (CKD) 患者未来发生自主神经功能障碍和心血管疾病的风险很高。本研究的目的是检查 12 个月的生活方式干预 (LI)，包括定期有氧运动对 CKD 患者心脏自主神经功能的影响。设计 汇总探索性分析。方法 113 名 3-4 期 CKD（eGFR 25-60 ml/min/1.75m2）符合条件的患者参加了 LI 计划，包括为期 8 周的个性化健身房锻炼计划，然后是 10 个月的家庭计划。对照组 (CON) 接受标准的肾脏病学护理。在 12 个月的研究期之前和之后评估了以下参数： 分级运动测试的心肺适能 (VO2peak)；心脏自主神经功能从时间、频率、心率变异性 (HRV)、峰值运动后心率 (HR) 恢复和运动期间变时能力的非线性测量。结果 与 CON 组相比，LI 组显着增加了 VO2peak（CON = -1.0 vs. LI = +1.8 ml/kg/min，p < 0.01），而任何 HRV 测量值均无显着改善（p = 0.85）， HR 恢复 (p = 0.38) 或变时能力 (p = 0.28)。相对 VO2peak 的变化与非线性 HRV 测量值 α1 的变化显着相关（p < 0.01），与年龄和 eGFR 无关（r2 = 0.196，p = 0.03）。结论 尽管 LI 组的心肺健康显着增加，但心脏自主神经功能没有变化。然而，α1 可能是评估该临床队列中 VO2peak 变化的敏感指标。