Chronic kidney disease (CKD) is a disease characterized by a progressive decrease in kidney function. The most common causes of kidney disease are hypertension (high blood pressure) and diabetes. Simultaneously CKD patients are at an increased risk of developing cardiovascular disease.
It is well-documented that exercise is important in maintaining health and preventing the development and progression of chronic diseases. There has been an increased interest in exercise as a role in potentially preventing, reducing, or maintaining CKD progression.
Key Points
- Exercise is an adjustable lifestyle modification that may positively affect the progression and course of CKD.
- Evidence suggests that exercise training improves muscle endurance, strength, physical function, and balance for all stages of CKD.
- Reduced physical activity in CKD patients can lead to a downward spiral between deconditioning, disease, and disuse, which may lead to increased mortality.
Kidney Function
The kidneys’ primary function is to remove waste products and excess water (fluids) from the bloodstream. Once the blood is filtered through the kidneys, the waste products and extra fluids are removed through urine. The filtered blood then returns back to the bloodstream through the veins.
The kidneys play a vital role in the following:
- Removing waste and toxic products from the blood
- Maintaining electrolyte (sodium, potassium, and calcium) homeostasis
- Producing an active form of vitamin D that helps healthy bones
- Releasing hormones that balance blood pressure
- The production of red blood cells
When you develop CKD, your kidneys no longer work as they should, with waste products and extra fluid returning to the bloodstream instead of out of the body through urine. This excess waste product and fluid build-up can cause damage to other organs in the body. CKD is a significant risk factor for the development of diabetes, heart disease, and hypertension.
Stages and Kidney Function
CKD progression can be broken down and categorized into five different stages. These stages are based on how well your kidneys are functioning (eGFR test). As the stages increase, so does the disease progression.
The early stages (stages 1-3a&b) are characterized by mild to moderate kidney damage, as the kidneys are still able to filter waste products and fluids out of the blood. The later stages (stages 4-5) of CKD are characterized by severe kidney damage and, ultimately, kidney failure.
Does CKD Always Progress?
CKD typically progresses slowly, however, not everyone will have the same rate of disease progression. Many people with CKD do not know they have it until symptoms start presenting, generally in stages 3 and 4.
There are factors that may increase the speed of disease progression:
- Hypertension (high blood pressure)
- Anemia
- Current smoker
- Acute kidney injury (AKI)
- Chronic diabetes
- Cardiovascular disease
- Proteinuria
Lifestyle, genetics, or other related medical conditions can further complicate CKD progression.
Exercise and Kidney Function
Patients with CKD may have reduced physical functioning and are not as fit (aerobically) as the general population.
Inactivity and reduced physical function during the CKD journey may be associated with affected disease progression, reduced quality of life, and increased mortality. Lack of exercise may also increase the risk of developing other life-threatening conditions such as hypertension, diabetes, and cardiovascular disease. The positive impact of exercise on hypertension, diabetes management, and cardiovascular disease is well documented.
How Does Exercise Help Patients With Kidney Disease?
Exercise can be described as a physical activity that is planned, structured, purposeful, and repetitive.
Exercise may have the following benefits for CKD patients:
- Decreased levels of cholesterol and triglycerides
- Better weight management
- Improved muscle functioning, strength, and conditioning
- Better control of blood pressure
- Prevention of muscle wasting
- Improvement of cardiovascular health
- Reduced chronic inflammation
Regular exercise has also proven to have mental health benefits in decreasing depression, stress, and anxiety in CKD patients.
Which Exercise Is Best for the Kidneys?
Before starting any exercise program, ensure that you talk to your primary care physician to ensure it best suits your needs.
While no single exercise is best for kidney health, aerobic activities using large muscle groups, such as walking, skiing, swimming, or cycling, are ideal. Strengthening exercises that are low-impact may also be beneficial.
Most studies suggest 20-60 minutes of exercise, two to three times a week. At the same time, the World Health Organization recommends a total of 150 minutes per week of moderate-intensity activity.
There are four things to consider when planning your exercise program:
- How hard (intensity) you will work while exercising
- How frequently will you exercise
- The types of exercise
- How long you will exercise for in each session
It is important to take into account that patients with CKD and ESRD may be weak, severely deconditioned, and frail. They may only be able to manage short 10 minute sessions of exercise a day to start.
Exercise in Dialysis Patients
ESRD patients that are on dialysis typically exhibit an increase in mortality and morbidity, which may be partly due to complications related to decreased physical function. An effective strategy to help combat or control some of the complications of dialysis treatment is exercise.
Small doses of physical activity amounting to up to 40 or 90 minutes per week have proven to reduce all-cause mortality in people with chronic diseases. Exercise may also help reduce emotions such as depression and anxiety caused by the nature of CKD and ESRD.
Exercise and Preventing CKD
Lifestyle modifications such as exercise, dietary improvements, and pharmacological approaches are highlighted as essential strategies for preventing and treating CKD. Exercise is an important component of reducing the risk of cardiovascular disease and improving or maintaining overall health for CKD patients.
Studies have shown that exercise can improve eGFR in non-dialysis CKD patients. Exercise has been shown to decrease renal blood flow for CKD patients with hypertension.
Considering the role of exercise in preventing CKD or CKD-related conditions, it is important for care teams to encourage CKD patients to be physically active and ensure that the intensity and dose of exercise are adjusted to the patient’s level of physical and functional ability.
Panoramic Health
Panoramic Health is a physician-led value-based kidney care platform that boasts 14 years of experience managing patient outcomes, utilizing our expansive nephrology provider platform.
Our vast experience and clinical expertise allow us to understand CKD and provide patients with holistic care coordination. Our value-based kidney care platform powers our predictive analytics and data-driven interventions, allowing us to provide patients with the right care when they need it.
