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.
Highlights
On the contrary, prolonged life expectancy is not equivalent to a healthier life expectancy at birth (HALE), which is defined by the World Health Organization as the average number of years of full health that a newborn could expect to live if he or she were to pass through life subject to the age-specific death rates and ill-health rates of a given newborn
On the November 2016, a group of international researchers and Nutrients 2021, 13, 1444 clinicians first met as the Global Renal Exercise (GREX) Working Group to discuss research priorities related to exercise in chronic kidney disease (CKD) at Chicago
A recent meta-analysis reported that glycogen synthesis rates are enhanced when carbohydrates and protein are co-ingested after exercise compared to carbohydrates only, when the added energy of protein is consumed in addition to, not in place of, carbohydrates, suggesting the importance of an increase in the energy intake [64]
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The proportion of facilities with ultrapure dialysate (endotoxin level in dialysate lower than 0.001 EU/mL) increased from 43.1% in 2009 to 74.6% in 2018 [3], and the number of patients treated with online hemodiafiltration increased dramatically from 16,853 (5.8% of all maintenance dialysis patients) in 2009 to 144,686 (42.0%) in 2019 in Japan [4] All of these improvements may contribute to a better quality of life and a lower mortality rate in dialysis patients in the world, the Japanese registry data show that the crude mortality rate in these patients has been almost the same, approximately 10%, in recent years [4]. The history and concepts of renal rehabilitation, the current status of the dialysis population, the implementation of renal rehabilitation in this population, and future perspectives are reviewed
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