Acute exercise during hemodialysis prevents the decrease in natural killer cells in patients with chronic kidney disease: a pilot study
To evaluate the acute response of natural killer (NK) cell subsets of chronic kidney disease patients submitted to intradialytic exercise in a randomized crossover study.
Nine patients were submitted to a single bout of 20-min intradialytic exercise and a control hemodialysis (HD) session with an interval of 7 days between them. Peripheral blood sample was collected at baseline, during HD and immediately after HD in each trial to evaluate the peripheral frequency of NK cells and their subsets (CD3-CD56bright and CD3-CD56dim), systemic cortisol concentrations, C-reactive protein (CRP), creatine kinase activity (CK), and urea and creatinine levels.
HD therapy induced a significant decrease in NK cells frequency (p = 0.039), NK CD3-CD56bright cells (p = 0.04), and CD3-CD56dim cells (p = 0.036). On the other hand, no significant alterations were observed in NK cells and NK subsets during and after intradialytic exercise trial (p > 0.05). Neither trial altered CRP levels or serum CK activity during and after HD therapy (p > 0.05). However, HD therapy increased cortisol concentrations after HD therapy (p = 0.034).
This study suggests the potential role of intradialytic exercise to prevent the decrease in peripheral frequency of NK cell subsets during HD therapy. Moreover, moderate intensity intradialytic exercise did not exacerbate the systemic inflammation or induce muscle damage during HD therapy.
KeywordsInflammation Hemodialysis Exercise NK cells Immune response
This study was funded by Brazilian agencies Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) (MCTI/2014), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS).
Compliance with ethical standards
Conflict of interest
The authors declared they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Ethics Committee of the Methodist University Center IPA. This study was registered in Registro Brasileiro de Ensaios Clínicos (U1111-1172-9511).
Informed consent was obtained from all individual participants included in the study.
- 1.Romão JR (2004) Chronic kidney disease: definition, epidemiology and classification. Bras J Nephrol 26:1–3Google Scholar
- 11.Xiang FF, Zhu JM, Cao XS, Shen B, Zou JZ, Liu ZH, Zhang H, Teng J, Liu H, Ding XQ (2015) Lymphocyte depletion and subset alteration correlate to renal function in chronic kidney disease patients. Ren Fail 5:1–8Google Scholar
- 12.Vacher-Coponat H, Brunet C, Lyonnet L, Bonnet E, Loundou A, Sampol J, Moal V, Dussol B, Brunet P, Berland Y, Dignat-George F, Paul P (2008) Natural killer cell alterations correlate with loss of renal function and dialysis duration in uraemic patients. Nephrol Dial Transpl 23:1406–1414CrossRefGoogle Scholar
- 13.Peraldi MN, Berrou J, Dulphy N, Seidowsky A, Haas P, Boissel N, Metivier F, Randoux C, Kossari N, Guérin A, Geffroy S, Delavaud G, Marin-Esteban V, Glotz D, Charron D, Toubert A (2009) Oxidative stress mediates a reduced expression of the activating receptor NKG2D in NK cells from end-stage renal disease patients. J Immunol 182:1696–1705CrossRefPubMedGoogle Scholar
- 14.Law BMP, Wilkinson R, Wang X, Kildey K, Lindner M, Rist MJ, Beagley K, Healy H, Kassianos AJ (2017) Interferon-γ production by tubulointerstitial human CD56 bright natural killer cells contributes to renal fibrosis and chronic kidney disease progression. Kidney Int 92:79–88CrossRefPubMedGoogle Scholar
- 17.Avesani CM, Trolonge S, Deleaval P, Baria F, Mafra D, Faxén-Irving G, Chauveau P, Teta D, Kamimura MA, Cuppari L, Chan M, Heimbürger O, Fouque D (2012) Physical activity and energy expenditure in haemodialysis patients: an international survey. Nephrol Dial Transpl 27:2430–2434CrossRefGoogle Scholar
- 18.Torino C, Manfredini F, Bolignano D, Aucella F, Baggetta R, Barillà A, Battaglia Y, Bertoli S, Bonanno G, Castellino P, Ciurlino D, Cupisti A, D’Arrigo G, De Paola L, Fabrizi F, Fatuzzo P, Fuiano G, Lombardi L, Lucisano G, Messa P, Rapanà R, Rapisarda F, Rastelli S, Rocca-Rey L, Summaria C, Zuccalà A, Tripepi G, Catizone L, Zoccali C, Mallamaci F, EXCITE Working Group (2014) Physical performance and clinical outcomes in dialysis patients: a secondary analysis of the EXCITE trial. Kidney Blood Press Res 39:205–211CrossRefPubMedGoogle Scholar
- 23.Borg G (1985) An introduction to Borg’s RPE scale. Movement Publications, IthacaGoogle Scholar
- 28.Pedersen L, Idorn M, Olofsson GH, Lauenborg B, Nookaew I, Hansen RH, Johannesen HH, Becker JC, Pedersen KS, Dethlefsen C, Nielsen J, Gehl J, Pedersen BK, Thor Straten P, Hojman P (2016) Voluntary running suppresses tumor growth through epinephrine- and IL-6-dependent NK cell mobilization and redistribution. Cell Metab 23:554–562CrossRefPubMedGoogle Scholar
- 33.Bigley AB, Rezvani K, Chew C, Sekine T, Pistillo M, Crucian B, Bollard CM, Simpson RJ (2014) Acute exercise preferentially redeploys NK-cells with a highly-differentiated phenotype and augments cytotoxicity against lymphoma and multiple myeloma target cells. Brain Behav Immun 39:160–171CrossRefPubMedGoogle Scholar
- 43.Giraldo E, Garcia JJ, Hinchado MD (2009) Exercise intensity-dependent changes in the inflammatory response in sedentary women: role of neuroendocrine parameters in the neutrophil phagocytic process and the pro-/anti-inflammatory cytokine balance. Neuro Immunol Modul 16:237–244Google Scholar
- 48.Bohm J, Monteiro MB, Andrade FP, Veronese F, Thomé FS (2017) Acute effects of intradialytic aerobic exercise on solute removal, blood gases and oxidative stress in patients with chronic kidney disease. J Bras Nefrol 27:0Google Scholar
- 49.Musavian AS, Soleimani A, Masoudi Alavi N, Baseri A, Savari F (2015) Comparing the effects of active and passive intradialytic pedaling exercises on dialysis efficacy, electrolytes, hemoglobin, hematocrit, blood pressure and health-related quality of life. Nurs Midwifery Stud 4:e25922CrossRefPubMedPubMedCentralGoogle Scholar