Renal Rehabilitation

Original Editor - Lucinda hampton Top Contributors - Kim Jackson and Manisha Shrestha

Description[edit | edit source]

Renal rehabilitation (RR) is a coordinated, multifaceted intervention designed to optimize a renal patient’s physical, psychological, and social functioning, thus reducing morbidity and mortality. RR includes five major components: such as exercise training, diet & fluid management, medication & medical surveillance, education, psychological & vocational counselling.[1]

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Renal Rehabilitation aims at improving Chronic kidney disease (CKD) patients QOL. The nephrology community felt the need to catch up with cardiology and pulmonary colleagues by adding renal rehabilitation programs for patients with chronic medical conditions, as the benefits to those with CKD on physical function and QOL are many.[2]

CKD is a worldwide public health problem. It is associated with reduced exercise endurance (VO2 max) which further reduces as the renal dysfunction advances. Poor physical condition and skeletal muscle wasting are associated with CKD, being due to the combined effects of uremic acidosis, protein-energy malnutrition and inflammatory cachexia and a sedentary lifestyle. A downward spiral of deconditioning then follows.

Indication[edit | edit source]

For people with Kidney disorders[edit | edit source]

A lot of people living with kidney disease find that their fitness levels suffer for a number of reasons. These include:- dietary restrictions; changes in muscle structure; changes in blood supply; lack of physical activity This leaves them may leave them feeling lethargic, weak, overweight and with a decreasing QOL. RR aims to redress these issues.

Renal Rehabilitation Programs[edit | edit source]

Rehabilitation programs are designed to improve everyday life of people suffering CKD, they go over a 6-12 week period typically.

After an initial assessment, a program is tailored to reach each person’s goals and the goals of practitioners and allied health professionals.

The below video gives an idea of what a RR program is like

[3]

The below video shows RR at work in a dialysis setting

[4]

Physiotherapy Management[edit | edit source]

Exercise Bike.gif

The physiotherapist input in the RR is to design a good comprehensive exercise program. They are held over 6-12 weeks with classes ranging between 1-2 hours, with participants committed to performing exercises at home on at least two other days a week.

The aims are to:

• Improve muscle strength, mobility and fitness

• Improve quality of life

• Reduce blood pressure

• Improve blood sugar control

• Improve your heart and lung function

• Control weight and improve self-esteem

• Counteract/reverse the side effects of steroidal treatment, such as muscle wasting, bone thinning and weight gain after transplant.[5]

The program should have a warm-up and cool down, a strengthening component, a cardiovascular component and flexibility section. The therapist also needs to monitor progression and educate clients in monitoring their progress.

Renal Rehabilitation Evidence[edit | edit source]

CKD is a progressive condition that adversely affects musculoskeletal health.

A 2018 study reported that secondary sarcopenia due to CKD is associated with malnutrition, osteoporosis, mobility limitations, and elevated fall risk. They found that supervised physiotherapy is an important element in the management of CKD clients to treat: secondary sarcopenia; improving QOL through enhanced cardiovascular fitness; in improving bone strength via strength training.[6]

A 2014 randomised controlled trial reported "A 12-week/24-session renal rehabilitation exercise program improved physical capacity and quality of life in patients with CKD stages 3 and 4. Longer follow-up is needed to determine if these findings will translate into decreased mortality rates."[7]

A systematic 2019 review found that:

  • RR in predialysis patients with CKD is suggested to improve or maintain exercise tolerance and improve the QOL related to physical functions. No solid evidence that exercise therapy improves the vital prognosis or renal outcome is shown to date.[8]
  • RR for dialysis recipients the social rehabilitation great and that physical ability and QOL were improved by exercise, which is a major component of renal rehabilitation. [8]

A systematic review and meta-analysis of randomized clinical trials suggested that intradialytic exercise protocols had positive outcomes in chronic kidney disease patients with poor cardiopulmonary function and reduced exercise tolerance and ventilatory efficiency[9]

References[edit | edit source]

  1. Renal Rehabilitation: Present and Future Perspectives By Masahiro Kohzuki Submitted: April 19th 2012Reviewed: August 30th 2012Published: February 27th 2013 DOI: 10.5772/52909 Available from : https://www.intechopen.com/books/hemodialysis/renal-rehabilitation-present-and-future-perspectives (last accessed 21.6.2019)
  2. Jhamb M, Weiner DE. Exercise to improve physical function and quality of life in CKD. Available from: https://cjasn.asnjournals.org/content/9/12/2023 (last accessed 23.6.2019)
  3. University of Delaware Renal rehab at UD combats chronic kidney disease Available from: https://www.youtube.com/watch?v=PpQfqp8cIe0 (last accessed 23.6.2019)
  4. AHS channel Exercise during dialysis study Available from: https://www.youtube.com/watch?v=nm2yWR6Unao&feature=youtu.be (last accessed 23.6.2019)
  5. Guys and St Thomas Renal Rehabilitation. Available from:https://www.guysandstthomas.nhs.uk/resources/patient-information/therapies/physiotherapy/renal-rehabilitation-webfriendly.pdf (last accessed 23.6.2019)
  6. Hernandez H, Obamwonyi G, Harris-Love M. Physical therapy considerations for chronic kidney disease and secondary sarcopenia. Journal of functional morphology and kinesiology. 2018 Mar;3(1):5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5784851/ (last accessed 22.6.2019)
  7. Rossi AP, Burris DD, Lucas FL, Crocker GA, Wasserman JC. Effects of a renal rehabilitation exercise program in patients with CKD: a randomized, controlled trial. Clinical journal of the American Society of Nephrology. 2014 Dec 5;9(12):2052-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4255415/ (last accessed 22.6.2019)
  8. 8.0 8.1 Yamagata K, Hoshino J, Sugiyama H, Hanafusa N, Shibagaki Y, Komatsu Y, Konta T, Fujii N, Kanda E, Sofue T, Ishizuka K. Clinical practice guideline for renal rehabilitation: systematic reviews and recommendations of exercise therapies in patients with kidney diseases. Renal Replacement Therapy. 2019 Dec;5(1):4. Available from: https://rrtjournal.biomedcentral.com/articles/10.1186/s41100-019-0209-8#Sec8 (last accessed 22.6.2019)
  9. Andrade FP, Rezende PS, Ferreira TS, Borba GC, Müller AM, Rovedder PME. Effects of intradialytic exercise on cardiopulmonary capacity in chronic kidney disease: systematic review and meta-analysis of randomized clinical trials. Scientific Reports. 2019 Dec 5;9(1):18470.