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Minireview

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Physical Exercise in Patients with Severe Kidney Disease

Kosmadakis G.C.a · Bevington A.b · Smith A.C.a · Clapp E.L.c · Viana J.L.c · Bishop N.C.c · Feehally J.a, b

Author affiliations

aThe John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester NHS Trust and bDepartment of Infection, Immunity and Inflammation, University of Leicester, Leicester, and cSchool of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK

Corresponding Author

Dr. George Kosmadakis

The John Walls Renal Unit, Leicester General Hospital

Gwendolen Rd, Leicester LE5 4PW (UK)

Tel. +44 116 258 4132, Fax +44 116 258 4764

E-Mail george.kosmadakis@googlemail.com

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Nephron Clin Pract 2010;115:c7–c16

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Abstract

Patients with advanced chronic kidney disease (CKD), especially those on long-term dialysis, often suffer from muscle wasting and excessive fatigue. It is known that inactivity, muscle wasting and reduced physical functioning are associated with increased mortality in CKD. Known causes include uraemic myopathy and neuropathy, inactivity, and anaemia. Exercise in patients receiving regular dialysis treatment for end-stage renal disease was first introduced 3 decades ago, but is still only offered in a minority of renal units around the world, despite a significant body of evidence to support its use. Work is needed to increase awareness of the potential benefits of increased physical activity for patients with advanced CKD. This review summarizes the mechanisms of exercise intolerance and debility in advanced CKD patients, the methods used for the estimation of functional capacity, the options currently available for exercise training, and their influence on the well-being of this group of patients.

© 2010 S. Karger AG, Basel



 

Editorial Comment


M. El Nahas, Sheffield

The minireview by Kosmadakis and colleagues from the UK reminds nephrologists of a topic that has long been neglected, namely that of the value of exercise in chronic kidney disease/end-stage renal disease (ESRD) patients. They review the evidence for the impact of lack of exercise on outcomes in ESRD patients on replacement therapy. They also examine carefully the potential physical and psychological benefits of aerobic, resistance and flexibility activities in haemodialysis patients. These include possible improved dialysis efficacy and blood pressure control. Attention should be paid to tailoring the exercise programme to the patient’s capabilities and underlying comorbidities. The authors conclude by calling for a randomized control study to settle the issue of physical inactivity in dialysis patients. Such a trial may be difficult to conduct in view of the case mix of patients on dialysis and the numerous confounders that affect their outcomes; the number of inconclusive clinical trials in dialysis patients is rapidly expanding, highlighting such difficulties.


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