Efeitos do exercício físico de força sobre os hormônios do apetite, estado nutricional e marcadores inflamatórios e cardiovasculares em pacientes em hemodiálise

Abstract

Introduction: Chronic Kidney Disease (CKD) patients undergoing hemodialysis (HD) present altered levels of apetite hormones as acyl-ghrelin (orixigenic) and obestatin (anorexigenic) which contributes to anorexia. Anorexia affects negatively the nutritional state and accelarates inflammation and comorbidities as cardiovascular diseases (CVD) leading to Protein-Energy Wasting (PEW) which cosists in decreased food intake and protein reservs, increased metabolic rate, inflammation and weight and muscular loss. Strategies as physical exercises have been purposed to conteract these clinical complications. Therefore, this study aimed to evaluate the effects of a resistance exercise program in inflammatory and cardiovascular biomarkers, appetite hormones and PEW in HD patients. Mehtods: This study included 52 patients on regular HD program. The group that performed exercises comprised 37 patients (56.7% male, age 45.5±10.8 years and 43.3% women, age 44.3±15.4 years, 57 (9-192) months on HD). The control group consisted of 15 patients (66.7% men, mean age 50 ± 12.7 years and 33.3% women, age 49.4 ± 4.8 years, 57 (11-153) months on HD). The patients had their blood drawn in a regular HD day after overnight fasting, before and after 6 months of exercise program. Plasma levels of obestatin, acyl-ghrelin, irisin and adhesion molecules (ICAM-1 and VCAM-1) were analyzed with enzymatic imunometric assay. Interleukin-6 (IL-6), C-reactive Protein (CRP) and tumor necrosis factor-alpha (TNF-&#945;) were analyzed (ELISA). Anthropometric parameters, food intake, appetite, physical capacity and PEW (simultanous presence of: BMI<23kg/m2, albumin <3.8g/dL and reduced arm muscular ciscumference) were analyzed. Quality of life was analyzed with SF-36 survey. Exercise program was supervised (performed with elastic bands and ankle cuffs in both lower limbs) 3 times a week during 6 months (72 sessions). Statistical analysis were assessed using R version 2.15.1 and SPSS version 19.0. Results: After six months of exercise there were no statistical diferences in appetite and food intake, however, obestatin levels reduced [3.0ng/mL (2.3-3.4) to 1.9ng/mL (0.6-3.4)], and acyl-ghrelin levels increased [21.5pg/mL (1.3-77.7) to 37.2pg/mL (16.7-94.1)]. Adhesion molecules reduced significantly [ICAM-1, 1,934.1pg/ml (1,031.8-2,875.0) to 1,571.1pg/mL (447.1-2,985.5),p<.05 and, VCAM, 5,259.51 pg/mL (6,682.4-3,967.4) to 3,062.1pg/mL (2,034.0-5,034.4),p<.05]. CRP levels reduced from 2.3±0.9pg/mL to 1.6±0.6pg/mL, p<.001. Body composition, physical capacity, physical functional assessed by SF-36 and albumin levels (3.7±0.3 para 3.9±0.2, p <.05) improved after exercises. The prevalence of patients with PEW reduced from 23.7% to 2.6%, p<.001. The multifatorial analysis showed that the decresed obestatin levels after intervention was associated with improved physical capacity, and acyl-ghrelin levels after exercises were associated with decreased adhesion molecules. Conclusion: Six months of resistance exercises contributed to changes in plasma appetite hormones and body composition in hemodialysis patients compared to the control group. Nutritional status and inflammation and cardiovascular biomarkers also improved in patients who performed exercise.