Early exercise therapy for acute nephrotic syndrome: a randomised clinical trial

Area of Science:

• Nephrology
• Exercise Physiology
• Clinical Trials

Background:

• Acute nephrotic syndrome (NS) frequently causes physical function decline in adults.
• Limited evidence and safety concerns regarding exercise therapy hinder its use in NS.
• Fear of worsening proteinuria and renal function often leads to avoidance of exercise in NS patients.

Purpose of the Study:

• To evaluate the efficacy and safety of early exercise therapy in hospitalized adults with acute NS.
• To determine if early exercise therapy enhances physical function (peak oxygen uptake).
• To assess the impact of exercise therapy on non-remission rates and kidney function.

Main Methods:

• A single-centre randomized controlled trial (RCT) involving hospitalized adults with NS receiving glucocorticoid therapy.
• Participants were randomized (1:1) to either early exercise therapy or standard care.
• Primary outcome: peak oxygen uptake (peak VO2) at 6 weeks. Secondary outcome: non-remission at 6 weeks (proteinuria ≥0.3 g/day).

Main Results:

• Twenty-seven participants were recruited (13 in early intervention, 14 in standard care).
• Peak VO2 significantly increased in the early exercise group (Δ = 3.45 mL/kg/min) compared to the standard care group (Δ = 1.00 mL/kg/min).
• No significant difference in non-remission risk between groups (Risk Ratio = 0.673; 95% CI, 0.266-1.703).

Conclusions:

• Early exercise therapy in acute NS patients demonstrated a clinically meaningful improvement in exercise tolerance.
• The between-group difference in peak VO2 did not reach statistical significance.
• No evidence suggests that early exercise therapy increases the risk of non-remission in acute NS.