BACKGROUND: Chronic kidney disease (CKD) is associated with a complex state of immune dysfunction resulting in inflammation and a higher risk of cardiovascular disease. Persistent immune cell activation contributes to a chronic inflammatory state. Exercise can improve immune function, provide anti-inflammatory effects and control the level of inflammatory mediators produced, namely Tumor Necrosis Factor-alpha (TNF-α). TNF is a pro-inflammatory cytokine that plays a role in several important functions in cells, such as proliferation, survival, differentiation, and especially the process of apoptosis. The effect of intradialytic aerobic cycling exercise on serum TNF-α levels has been widely studied, but the results of this study are still varied. This study aimed to evaluate the effect of a 12-week intradialytic aerobic cycling exercise program on Serum TNF-α levels s in CKD patients during regular hemodialysis. METHODS: Thirty CKD patients from Hemodialysis Installation of Dr. Soetomo Hospital Surabaya Indonesia participated in this study. The subjects were randomized into two groups; 15 patients were in the exercise (EXE) group, and 15 patients were in the control (CON) group. The EXE group underwent an intradialytic aerobic cycling exercise program twice per week for 12 weeks in addition to their standard care, while the CON group continued their standard care only. SerumTNF-α levels (pg/mL) was checked before and after 12 weeks of intervention. The normality test was performed using the Shapiro-Wilk test. Lavene’s Test was used to compare subjects’ characteristics between groups at the baseline. Changes in serum TNF-α levels (post- vs. pre-intervention) of each group were analyzed using paired t-test or Wilcoxon Test. The change in the serum levels between EXE and CON groups was compared using an independent T-test or Mann Whitney test. Statistical significance was set to P<0.05. Four patients dropped out in this study. RESULTS: This study showed that serum TNF-α levels s in EXE group decreased (Δ post-pre -72.997±73.85 pg/mL) while the serum TNF-α levels s in CON group increased (Δ post-pre 111.99±78.89). Change in the serum level in the EXE and CON groups was non-statistically significant (P=0.861 and 0.753, respectively). Change in serum TNF-α levels in the EXE group was non-statistically significant different than the CON group (P=0.701). CONCLUSIONS: Results suggest that intradialytic aerobic cycling exercise for 12 weeks could have a potential effect on decreasing serum TNF-α levels in chronic kidney disease patients undergoing regular hemodialysis.
- Chronic renal insufficiency
- Tumor necrosis factor-alpha