Description
Renal rehabilitation (RR) is a coordinated, multifaceted intervention aimed at optimizing psychophysical and social functioning in patients with kidney disease, thereby reducing morbidity and mortality. RR consists of five main components: such as exercise training diet and fluid management medications and Medical Supervision Educational Psychology and Career Counseling[1]
Renal rehabilitation aims to improve the quality of life of people with chronic kidney disease (CKD). Nephrology community sees need to catch up with cardiology and pulmonology peers in increasing renal rehabilitation programs for patients with chronic disease as it benefits CKD patients Physical function and QOL a lot. [2]
CKD is a worldwide public health problem. It is associated with decreased exercise tolerance (VO2 max), which decreases further with the progression of renal dysfunction. Poor body condition and skeletal muscle atrophy associated with CKD due to combined effects of uremic acidosis Protein energy malnutrition and inflammatory cachexia with a sedentary lifestyle. A vicious cycle ensues.
Indication
For people with Kidney disorders
- Nephritis/nephrosis,
- Chronic kidney disease, such as polycystic kidney disease, diabetic nephropathy. Alcoholic kidney
- Dialysis therapy
- Kidney transplantation
Many people with kidney disease find that their fitness levels are compromised for a number of reasons. These include: – dietary restrictions; changes in muscle structure; changes in blood supply; lack of physical activity which makes them likely to feel lethargic weak overweight and Reduced quality of life. RR aims to solve these problems.
Renal Rehabilitation Programs
Rehabilitation programs are designed to improve the daily life of people with CKD, and they typically last 6-12 weeks.
After an initial assessment, a plan is tailored to meet each individual’s goals as well as those of the practitioner and allied health professional.
The video below gives you an idea of what the RR program is like
[3]
The video below shows the RR in action in a dialysis environment
[4]
Physiotherapy Management
A physical therapist’s focus in the RR is to develop a good, comprehensive exercise program. It is held for 6-12 weeks with classes ranging from 1-2 hours with participants committing to working out at home at least two extra days per week.
The aims are to:
• Improve muscle strength circulation and fitness
• Improve quality of life
• Reduce blood pressure
• Improve blood sugar control
• Improve your heart and lung function
• Control your weight and improve your self-esteem
• Counteract/reverse side effects of steroid therapy such as muscle wasting osteoporosis and weight gain after transplantation.[5]
The program should have a strengthening warm-up and cool-down component with a cardiovascular component and a transition component. The therapist should also monitor progress and educate clients on monitoring their progress.
Renal Rehabilitation Evidence
CKD is a progressive condition that adversely affects musculoskeletal health.
A 2018 study reported that sarcopenia secondary to CKD is associated with malnutrition osteoporosis mobility limitations and an increased risk of falls. Physical therapy management was found to be an important component in the management of CKD patients for the treatment of: secondary sarcopenia; Improving QOL by improved cardiovascular fitness; in improving bone strength through strength training.[6]
A 2014 randomized 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 are significant under to reduce mortality or dose.[7]
A systematic 2019 review found that:
- RR in patients with predialytic CKD is proposed to improve or maintain exercise tolerance and improve QOL related to physical functions . . . . No strong evidence that exercise therapy improves vital prognosis or renal outcome has been shown to date.[8]
- RR for dialysis recipients the social rehabilitation greatly and that physical capacity and QOL were improved by exercise which is an important component of renal rehabilitation. [8] .
A systematic review and meta-analysis of randomized clinical trials showed positive outcomes of dialytic exercise interventions in patients with kidney disease chronic disease with poor cardiopulmonary function and reduced exercise tolerance and ventilation
References
- ↑ 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)
- ↑ 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)
- ↑ 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)
- ↑ AHS channel Exercise during dialysis study Available from: https://www.youtube.com/watch?v=nm2yWR6Unao&feature=youtu.be (last accessed 23.6.2019)
- ↑ 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)
- ↑ 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)
- ↑ 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)
- ↑ Jump up to: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)
- ↑ 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.
