Authors
Junichi Hoshino, Keisuke Kida, Shizuka Kobayashi, Kenichi Kono, Ryota Matsuzawa, Yuhei Otobe, Keisei Kosaki, Masahiko Yazawa, Yohei Tsuchida, Toshiaki Usui, Yuta Ouchi, Hiroki Nishiwaki, Takeshi Hasegawa, Naohiko Fujii, Tadashi Sofue, Kunihiro Yamagata, Yugo Shibagaki, Ichiei Narita
Published in
Clinical journal of the American Society of Nephrology : CJASN. Jul 10, 2026. Epub Jul 10, 2026.
Abstract
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.
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.
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.
Intradialytic renal rehabilitation may be associated with better survival in maintenance hemodialysis patients, particularly in men and in those with severe frailty.
PMID:
42455635
Bibliographic data and abstract were imported from PubMed on 15 Jul 2026.
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