Exercise and Kidney Disease

Stretching Out (Photo credit: Tyne & Wear Archives & Museums)

Exercise has proven health benefits in the normal population. These benefits are tied in some instances to weight loss. However the health benefits of exercise exceed that of weight loss alone. In a recent press release the American Society of Nephrology has made the statement "getting off the couch could could lead to a longer life for kidney disease patients." Based on a study which will be published in the Clinical Journal of the American Society of Nephrology (CJASN).

The mortality among patients with CKD is driven unexpectedly by cardiovascular disease implying that the function of these two organs although quite different on paper, are closely related on some more fundamental level that is not readily apparent. Although there are many theories as to how this may occur. The one that I consider the most likely to be true suggests that cardiovascular disease in chronic kidney disease is modulated primarily by inflammation and as pro-inflammatory states go CKD is pretty bad.

I think the findings of this study are to be expected, there is absolutely no evidence to suggest that patients with kidney disease would not derive benefit from exercise. Where this study is likely to have a significant impact is in the promotion of a healthy lifestyle choices among patients with kidney disease. Too frequently patients with CKD are sedentary a finding echoed by the investigators of this study.

Patients on dialysis are particularly prone to the ill effects of a sedentary lifestyle. The fact that dialysis usually occupies in the region of 12 hours out of the productive week usually leads to less exercise among this patient group. In addition to that there is the question of co-morbidities which may prevent exercise and a general feeling of fear and lack of confidence in exercising among some patients to contend with and already you see that this is likely to be an uphill struggle.

Unfortunately patients on dialysis are at very high risk of cardiovascular disease and as such they have the most to benefit from exercise. Consider for example that the traditional role of cholesterol as a risk factor for cardiovascular disease in the normal population is not as strongly supported in the dialysis population, add to that the still murky roles of non traditional risk factors such as PTH and phosphate and you will understand that a traditional risk factor such as lack of exercise may very well be a blessing and one of the most easily and cheaply modifiable targets for intervention.

[caption id="" align="alignnone" width="308" caption="Dialysis Exercise"][/caption]

There are machines available that will allow patients on dialysis to pedal against increasing resistance while having dialysis. These should be more widespread, patients on dialysis are essentially a captive audience for such an intervention. They are safe in the vast majority of patients and allow for previously sedentary time 4 hours three times a week to be used as part of the requirements for exercise. Even 20 minutes per dialysis session of resistance cycling is likely to have a positive effect.

Maybe as a result of this study we will see dialysis chairs with attached bicycles and spinning instructors becoming a part of the dialysis process. At least I hope so.