Supplementary Material for: Physical Activity in Renal Disease (PAIRED) and the effect on hypertension: a randomized controlled trial

Introduction: Exercise is an effective strategy for blood pressure (BP) reduction in the general population, but efficacy for the management of hypertension in CKD is not known. We evaluated the difference in 24-hour ambulatory systolic BP with exercise training in people with moderate to severe chronic kidney disease (CKD). Methods: Participants with an estimated glomerular filtration rate (eGFR) of 15-44 mL/min per 1.73m2 and SBP >120 mmHg were randomized to receive thrice weekly, moderate intensity aerobic-based exercise over 24 weeks, or usual care. Phase 1 included supervised in-center and home-based sessions for eight weeks. Phase 2 was 16 weeks of home-based sessions. BP, arterial stiffness, cardiorespiratory fitness, and markers of CV risk were analyzed using mixed linear regression. Results: We randomized 44 people; 36% were female, median age was 69 years, 55% had diabetes and the median eGFR was 28 mL/min per 1.73m2. Compared with usual care, there was no significant change in 24-ambulatory SBP at eight weeks 2.96 mmHg (95% CI -2.56, 8.49) or 24 weeks. Peak oxygen uptake improved by 1.9 mL/kg/min in the exercise group (95% CI 0.03, 3.79) at eight weeks with a trend toward higher BMI 1.84 kg/m2 (95% CI -0.10, 3.78) and fat free mass, but this was not sustained at 24 weeks. Markers of CV risk were unchanged. Conclusions: Despite an improvement in VO2peak and body composition, we did not detect a change in 24-hour ambulatory systolic BP in people with moderate to severe chronic kidney disease.引言：运动是普通人群降低血压（blood pressure，BP）的有效手段，但运动对慢性肾脏病（chronic kidney disease，CKD）患者高血压的管理效果尚不明确。本研究针对中重度慢性肾脏病（CKD）患者，评估运动训练对其24小时动态收缩压的影响差异。 研究方法：本研究纳入估算肾小球滤过率（estimated glomerular filtration rate，eGFR）为15~44 mL/min/1.73m²、收缩压（systolic blood pressure，SBP）＞120 mmHg的受试者，将其随机分为两组：一组接受每周3次、中等强度有氧训练，持续24周；另一组接受常规护理。第一阶段共8周，包含监督下的中心室内训练与居家训练两种形式；第二阶段为16周，仅开展居家训练。本研究采用混合线性回归模型分析受试者的血压、动脉僵硬度、心肺适能及心血管（cardiovascular，CV）风险标志物水平。 研究结果：本研究共纳入44名受试者，其中女性占比36%，中位年龄为69岁，55%的受试者合并糖尿病，中位eGFR为28 mL/min/1.73m²。与常规护理组相比，干预8周及24周时，受试者的24小时动态收缩压均未出现显著变化：8周时差值为2.96 mmHg（95%置信区间：-2.56~8.49），24周时亦无显著差异。干预8周时，运动组的峰值摄氧量较基线提升1.9 mL/kg/min（95%置信区间：0.03~3.79），体重指数（body mass index，BMI）及去脂体重呈升高趋势，差值分别为1.84 kg/m²（95%置信区间：-0.10~3.78）及对应水平，但上述变化在24周时未持续存在。心血管风险标志物水平未发生显著变化。 结论：尽管运动可改善中重度慢性肾脏病患者的峰值摄氧量与身体成分，但本研究未观察到其24小时动态收缩压出现显著变化。