Renal Rehabilitation: Exercise Intervention and Nutritional Support in Dialysis Patients

Abstract

With the growing number of dialysis patients with frailty, the concept of renal rehabilitation, including exercise intervention and nutrition programs for patients with chronic kidney disease (CKD), has become popular recently. Renal rehabilitation is a comprehensive multidisciplinary program for CKD patients that is led by doctors, rehabilitation therapists, diet nutritionists, nursing specialists, social workers, pharmacists, and therapists. Many observational studies have observed better outcomes in CKD patients with more physical activity. Furthermore, recent systematic reviews have shown the beneficial effects of exercise intervention on exercise tolerance, physical ability, and quality of life in dialysis patients, though the beneficial effect on overall mortality remains unclear. Nutritional support is also fundamental to renal rehabilitation. There are various causes of skeletal muscle loss in CKD patients. To prevent muscle protein catabolism, in addition to exercise, a sufficient supply of energy, including carbohydrates, protein, iron, and vitamins, is needed. Because of decreased digestive function and energy loss due to dialysis treatment, dialysis patients are recommended to ingest 1.2-fold more protein than the regular population. Motivating patients to join in activities is also an important part of renal rehabilitation. It is essential for us to recognize the importance of renal rehabilitation to maximize patient satisfaction.

Effect of Exercise on Health-Related Quality of Life in Patients with End-Stage Renal Disease

“…Patients with severe renal impairment benefit equally from resistance and balance exercises, which both increase physical activity and improve renal function. Thus, to enhance the therapy effects of exercise in dialysis patients, it is better to combine these components in a balanced fashion or to change them individually [20].…”

“…On days when they are not receiving dialysis, dialysis patients are 17% less physically active than non-dialysis patients. With decreased physical activity comes several risks, such as catabolic disorders that can cause muscle loss and lead to sarcopenia, mitochondrial dysfunction, and other conditions such as anaemia, mineral disorders, protein energy loss, diabetes, neurological dysfunction, and cardiovascular dysfunction [20]. Dialysis patients may also be at risk for these conditions.…”

Extension of Healthy Life Span of Dialysis Patients in the Era of a 100-Year Life

“…It is increasingly recognized that sarcopenia is one of main factors leading to impaired QOL in the elderly population, such as in HD patients [ 3 ]. To counteract age-related development of sarcopenia in HD patients, multifaceted intervention including both nutritional and physical therapy is needed [ 3 , 4 ]. In addition to the maintenance of muscle mass, the importance of maintaining fat mass should be emphasized in elderly undernourished HD patients.…”

“…In the future, new MRI technology may provide clues regarding appetite loss in HD patients. In addition to sufficient energy intake, exercise is also required to prevent muscle protein catabolism [ 3 , 4 ]. Renal rehabilitation has received much attention in clinical practice [ 4 ].…”

“…In addition to sufficient energy intake, exercise is also required to prevent muscle protein catabolism [ 3 , 4 ]. Renal rehabilitation has received much attention in clinical practice [ 4 ]. Comprehensive care by a wide variety of medical staff is essential for the wellbeing of elderly HD patients.…”