# Resistance exercise exerts anti-hypertensive effects and downregulates NTPDase/CD39 and ecto-5′-nucleotidase/CD73 expression in patients with chronic kidney disease undergoing hemodialysis

## TL;DR

Resistance exercise lowers blood pressure and reduces enzyme activity linked to purinergic signaling in CKD patients on hemodialysis.

## Contribution

This study shows resistance exercise mitigates purinergic signaling and has anti-hypertensive effects in CKD patients.

## Key findings

- Resistance exercise significantly reduced systolic blood pressure in CKD patients.
- NTPDase/CD39 and ecto-5′-nucleotidase/CD73 expression were downregulated after resistance exercise.
- Extracellular ATP levels were restored in CKD patients following resistance exercise.

## Abstract

Chronic kidney disease (CKD) affects approximately 13.4% of the global population and significantly impacts patients’ quality of life. This study aimed to investigate the effects of resistance exercise on blood pressure and purinergic signaling in patients with CKD. Here, 28 patients with CKD performed a 12-week resistance exercise protocol during hemodialysis. Blood samples were collected before and after the intervention. Biochemical analyses, for example, NTPDases, ecto-5′-nucleotidase, and adenosine deaminase, were measured in platelets. Flow cytometry was performed to investigate CD39 and CD73 expression on lymphocytes. In addition, extracellular ATP and blood pressure were analyzed. Our findings revealed that patients with CKD present high systolic blood pressure (p = 0.0002) compared to control, and resistance exercise reduces blood pressure in these patients (p = 0.007). Regarding purinergic signaling, an increase in NTPDases, ecto-5′-nucleotidase, and adenosine deaminase was observed in patients with CKD (p = 0.0001; p = 0.0001; p = 0.0001; p = 0.0007, respectively). Surprisingly, after resistance exercise, NTPDase/ATP and ecto-5′-nucleotidase decreased (p = 0.0006; p = 0.02). CD39 and CD73 expression significantly increased on lymphocytes of CKD patients compared to control (p = 0.004; p = 0.0002, respectively). After resistance exercise, CD39 and CD73 expression was downregulated. Extracellular ATP levels were decreased in CKD (p = 0.0001), and resistance exercise restored these levels. In conclusion, CKD patients present high activity and expression of CD39 and CD73 enzymes, and resistance exercise mitigated purinergic exacerbation and presents anti-hypertensive effects in patients with CKD.

The online version contains supplementary material available at 10.1007/s11302-025-10121-7.