Discussion
CVDs, CKD, cancer, CVD, ESRD
CVD, CANCER, ESRD, INFLAMMATION
The present study investigated the effects of exercise training on protein expression in patients on hemodialysis by comparing the altered protein expression levels before and after the exercise intervention. The significantly enriched proteins were involved in the immune response on protein functional analysis. Some main proteins, which demonstrated significant changes, were also validated through ELISA. In addition, the protein expression levels of patients on dialysis were compared with those of a healthy age-matched control group, confirming the effect of exercise on improving the levels of these proteins.CKD is an independent risk factor for various adverse health issues, particularly CVDs. The age-adjusted mortality of CVD is much higher than the mortality of the general population, ranging approximately 15–30 times [Previous studies have reported a relationship between poor physical activity and high mortality in patients with CKD. Several trials have shown the effect of exercise on improving physical function and outcomes in patients with CKD. The largest randomized clinical trial conducted by Rossi et al. showed that 12-week/24-session renal rehabilitation exercise intervention improved the quality of life and physical function [Although studies investigating the effects of exercise on improving cardiovascular risk in patients with CKD are rare, some studies have reported beneficial cardiac outcomes observed in exercise interventions in this population [Recent studies have suggested that the immune system plays an important role in cardiac function and composition [Furthermore, previous studies have suggested that regular exercise could reduce pro-inflammatory cytokine secretion and even modulate the immune system, eventually reducing the risk of CVD and cancer [MMP-9 is secreted by different immune-related cells [The serum level of fetuin-B, the protein encoded by the Although studies investigating the effect of ACVR1B on CVD are scarce, it is known that ACVR1B belongs to the TGFT-b superfamily and contributes to the resolution of inflammation. In a gene analysis study, There are some limitations of the study that warrant discussion. First, the study population was small, and the duration of exercise intervention was relatively short. Further investigations involving a larger number of patients over a longer period of exercise intervention are needed to prove the immune response-related beneficial effects of exercise. Second, we could not analyze the protein expressions of the healthy age-matched control group. However, we strengthened the results by confirmation using ELISA validation with this control group. In addition, we could not investigate the direct correlation between improvement in physical function and the levels of expressed proteins. As no previous studies have investigated changes in protein levels after exercise using proteomic profiling, the present study, which evaluated the effect of exercise by analyzing molecular level changes using a high-confidence proteomic method, would be meaningful. We also used functional analysis to confirm the potential role of the significantly changed proteins and strengthened the results by confirmation using ELISA analysis.In conclusion, exercise in dialysis-dependent patients with CKD could enhance physical activity, which is a modifiable factor associated with reducing cardiovascular risk and mortality in the study population. The proteomic profiling results of protein expression changes after exercise might imply that the immune response is associated with this change in these patients. To investigate the beneficial effects of exercise on improving the outcomes of patients with ESRD on dialysis, we need more studies with longer intervention periods and larger patient populations.