Effects of intradialytic bicycle ergometer exercise on transcription factors NF-ĸB and Nrf2 in patients with chronic kidney disease: A randomized crossover clinical trial

J Bodyw Mov Ther. 2024 Oct:40:1492-1501. doi: 10.1016/j.jbmt.2024.08.003. Epub 2024 Aug 8.

Abstract

Purpose: To evaluate the effects of an intradialytic aerobic exercise training program on the expression of transcription factors nuclear factor κappa B (NF-κB) and nuclear factor erythroid 2-related factor 2 (Nrf2), related to inflammatory and antioxidant pathways, respectively, in patients with chronic kidney disease (CKD) on hemodialysis.

Methods: This was a longitudinal, randomized clinical trial with a washout period and crossover performed with 33 patients randomized into two groups: Exercise (individualized intradialytic aerobic exercise on an adapted stationary exercise bike) three times per week for three months and control (without exercise). After the washout period (1 month), the exercise group became the control, and the other group performed the exercises for another three months. Blood sample collection, food intake, and anthropometry were evaluated at the beginning and end of each study phase. Nrf2, its target gene NAD(P)H quinone oxidoreductase 1 (NQO1), and NF-κB transcription factors were evaluated by quantitative real-time polymerase chain reaction (qRT-PCR) and the inflammatory cytokines tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) by ELISA assay.

Results: Eighteen patients [11 men, 44.1 ± 8.4 years, 17.3 (6.6-124) months on HD] completed all the study. The obtained data revealed that the intervention did not affect Nrf2, NQO1, and NF-κB mRNA expression. Also, TNF-α levels were not changed. However, IL-6 showed a tendency to decrease after the exercise intervention (p = 0.054).

Conclusion: In hemodialysis patients, three months of intradialytic aerobic exercise did not modulate the transcription factors associated with inflammation (NF-κB) and antioxidant activity (Nrf2 and NQO1).

Clinical trials registration number: NCT04375553.

Keywords: Chronic kidney disease; Hemodialysis; Inflammation; Oxidative stress; Physical exercise.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Cross-Over Studies*
  • Exercise / physiology
  • Exercise Therapy / methods
  • Female
  • Humans
  • Interleukin-6 / blood
  • Interleukin-6 / metabolism
  • Longitudinal Studies
  • Male
  • Middle Aged
  • NAD(P)H Dehydrogenase (Quinone)* / metabolism
  • NF-E2-Related Factor 2* / metabolism
  • NF-kappa B* / metabolism
  • Renal Dialysis*
  • Renal Insufficiency, Chronic* / metabolism
  • Renal Insufficiency, Chronic* / therapy
  • Tumor Necrosis Factor-alpha / blood
  • Tumor Necrosis Factor-alpha / metabolism

Substances

  • NF-E2-Related Factor 2
  • NF-kappa B
  • NAD(P)H Dehydrogenase (Quinone)
  • NFE2L2 protein, human
  • Tumor Necrosis Factor-alpha
  • Interleukin-6
  • NQO1 protein, human

Associated data

  • ClinicalTrials.gov/NCT04375553