The accumulation of uremic toxins is detrimental to physiological systems and induces premature biological aging. Renal function assessment methods, such as predictive formulas, may be influenced by ancestry in Brazilians, given the country's ethnic diversity, resulting in inaccurate estimates. On the other hand, physical exercise is an important ally in treating chronic kidney disease (CKD) as it induces metabolic changes that help slow the disease's progression. Additionally, the anti-aging effect conferred on those who engage in physical exercise is widely recognized. However, investigations into the impact of physical exercise on the concentration of uremic toxins and biological aging in patients with chronic kidney disease and their relationship with ancestry are still in the early stages and inconclusive. The investigators aim to track uremic toxins, exerkines, genetic aspects, nutritional profile, physical fitness, body composition, and the effects of different types of physical training (periodized and progressive) in people with chronic kidney disease at various stages. Additionally, to verify associations between these factors and their effects on different physiological systems. This is a triple-blind randomized clinical trial, with a 10-year follow-up of patients. The sampling will be non-probabilistic in terms of accessibility or convenience. Adult volunteers of both biological sexes aged 18 or older, with chronic kidney disease in conservative treatment (stages 2, 3, 4, and 5, n\~400), patients undergoing renal replacement therapy (hemodialysis or peritoneal dialysis, n\~800), and transplant recipients (n\~400) will be recruited from different hemodialysis centers. After being grouped by disease stage, patients will be randomized according to pre-training variables and then allocated to the following groups: control group (CTL; at least n\~100), strength training (ST; at least n\~100), aerobic training (AT; at least n\~100), and combined training (CT; at least n\~100). The patients will undergo evaluations of body composition, cardiorespiratory capacity, muscle strength, autonomic nervous system function, and nutritional, psychological, and biomolecular assessments. The training protocols will be adjusted according to the patient's physical capacity, always considering periodization and progression.
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Concentrations of uremic toxins - Indoxyl sulfate
Timeframe: Every two months, over a follow-up period of at least 6 months and up to 10 years.
Concentrations of uremic toxins - p-Cresyl sulfate
Timeframe: Every two months, over a follow-up period of at least 6 months and up to 10 years.
Concentrations of uremic toxins - hippuric acid
Timeframe: Every two months, over a follow-up period of at least 6 months and up to 10 years.
Concentrations of uremic toxins - trimethylamine N-oxide
Timeframe: Every two months, over a follow-up period of at least 6 months and up to 10 years.
Concentrations of uremic toxins - screening
Timeframe: Every two months, over a follow-up period of at least 6 months and up to 10 years.
Serum albumin
Timeframe: Every two months, over a follow-up period of at least 6 months and up to 10 years.
Creatinine
Timeframe: Every two months, over a follow-up period of at least 6 months and up to 10 years.
Cystatin C levels
Timeframe: Every two months, over a follow-up period of at least 6 months and up to 10 years.
Estimation of renal function in patients undergoing conservative treatment
Timeframe: Every two months, over a follow-up period of at least 6 months and up to 10 years.