Clin J Am Soc Nephrol. 2026 Jul 10. doi: 10.2215/CJN.0000001133. Online ahead of print.
ABSTRACT
BACKGROUND: Frailty and sarcopenia are increasingly common among patients undergoing maintenance hemodialysis. Globally, some countries including Japan have recently introduced insurance reimbursement for intradialytic renal rehabilitation, a supervised intradialytic exercise instruction plus nutritional and lifestyle guidance. However, the survival benefit has not been fully evaluated.
METHODS: We evaluated 708 adult dialysis outpatients (age, 69.8±11.2; men, 59%; and Clinical Frailty Scale≥6, 13%) at 10 institutions across Japan in January 2021 who were retrospectively assessed over a three-year period, including 228 patients who received intradialytic renal rehabilitation, defined as supervised intradialytic exercise instruction plus nutritional and lifestyle guidance (≥1 session/week for ≥1 month), and 480 who did not receive this intervention. Cox regression models and propensity score (PS) matching were used to compare three-year mortality after adjustment for the Clinical Frailty Scale, comorbidities, laboratory data and other baseline characteristics.
RESULTS: During the follow-up, deaths were observed in 14.9% of the rehabilitation group and 23.1% of the non-rehabilitation group (P=0.01). Three-year survival was higher with rehabilitation (84.6% vs 75.6%, P = 0.007), particularly among men and those with severe frailty. In Cox models, renal rehabilitation was consistently associated with lower mortality (crude HR 0.59 [95% CI, 0.40-0.87]; adjusted HR 0.66 [0.44-1.00]). After propensity score matching, the association remained directionally similar (HR 0.65 [0.40-1.05]). Sex-stratified analyses suggested a stronger association among men (adjusted HR 0.49 [0.27-0.89]) than among women (adjusted HR 0.98 [0.54-1.77]), although the formal test for interaction was not statistically significant (P for interaction = 0.13). Patients meeting exercise-habit criteria (≥2 sessions/week, ≥30 min for ≥1 year) also showed better survival relative to the non-exercise-habit group (adjusted HR 0.60 [0.37-0.96], P = 0.03). No adverse events related to rehabilitation were reported.
CONCLUSIONS: Intradialytic renal rehabilitation may be associated with better survival in maintenance hemodialysis patients, particularly in men and in those with severe frailty.
PMID:42455635 | DOI:10.2215/CJN.0000001133
