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People with non-dialysis chronic kidney disease (CKD) are 5 to 10 times more likely to die of cardiovascular disease (CVD) than the general public, and the risk for dialysis-dependent clients is even higher. Physical activity is an important lifestyle modification for cardiovascular risk reduction.
Evidence from moderate quality systematic reviews suggest exercise improves physical fitness, physical functioning, muscle strength, and health-related quality of life. There is a clinically significant reduction in resting systolic blood pressure for dialysis-dependent CKD clients. Exercise alleviates symptoms of CKD, such as depression, tiredness, and restless leg syndrome. Additionally, there is emerging evidence that exercise might improve estimated glomerular filtration rate (eGFR) in CKD stages 3-4.
Physical Activity and Chronic Kidney Disease
Physical activity is recommended for all persons with CKD and end-stage renal disease (ESRD), unless specified otherwise. Physical activity has been proven to be safe for low-risk clients with stable CKD. It is important to assess each client individually, taking into consideration their age, renal function, and degree of proteinuria. An Australian position statement recommends all clients receive baseline cardiopulmonary exercise testing. Those on dialysis are severely deconditioned and may need physiotherapy referral.
Clinical guidelines recommend that people with CKD and ESRD should engage in at least 30 minutes of moderate-intensity physical activity on five days per week. Engaging in both aerobic (i.e., jogging) and resistance (i.e., lifting weights) exercise maximizes health benefits.
Physical Activity and Dialysis
People on dialysis face significant and unique barriers to exercise which should be addressed. These including fatigue, dyspnea, muscle wasting, and functional limitations. Many have comorbid conditions (i.e., CVD and osteoarthritis) which prevent activity.
Exercise programs in dialysis clients should be supervised. When supervised by a clinician, intradialytic exercise was found to be safe and enhanced the efficacy of dialysis. With regard to peritoneal dialysis, a systematic review found some cases of dialysate leaks during exercise. There is also concern for hernias with resistance training.
Useful Resources
Chronic Kidney Disease (British Association of Sport & Exercise Medicine, United Kingdom)
Chapter 5 of this comprehensive guide for health practitioners on physical activity provides brief bites of key information on chronic kidney disease.
Unique strategies for improving the effectiveness of exercise training in patients with kidney failure (American Kidney Fund, USA)
A webinar by Dr. Ken Wilund offered by the American Kidney Fund.
Click here for resources designed for clients
Further Reading
Last updated: November 2021