Chronic Kidney Disease is a New Target of Cardiac Rehabilitation

Abstract

Chronic heart failure is increasingly prevalent worldwide and is associated with significant morbidity and mortality. The Cochrane review demonstrated that cardiac rehabilitation (CR) resulted in improvements in QOL and a reduction in long-term mortality. Chronic kidney disease (CKD) is another worldwide public health problem. This review focuses on the importance and efficacy of rehabilitation for CKD patients as a new target of CR. Patients with CKD on hemodialysis (HD) have a high mortality rate, with cardiovascular diseases, such as chronic heart failure. A new systematic review and meta-analysis of randomized controlled trials reported that exercise-based renal rehabilitation improved aerobic capacity, muscular functioning, cardiovascular function, walking capacity, and QOL in CKD patients with HD. Moreover, exercise training may have renal protective effects, not only in some animal models of pre-HD CKD, but also in pre-HD CKD patients. Exercise therapy could be an effective clinical strategy in improving renal function, lowering the need for renal replacement therapy, such as HD, and reducing renal transplant risk in pre-HD CKD patients. This led the Ministry of Health, Labor and Welfare of Japan to extend renal rehabilitation partial coverage to stage 4 pre-HD CKD patients for the first time in the world in 2016.