Introduction:
The idea of renal rehabilitation, which includes fitness interventions and nutritional therapies for individuals with chronic kidney disease (CKD), has recently gained popularity due to the number of delicate dialysis patients. Medical professionals, rehabilitation professionals, registered dietitians, nursing experts, social workers, pharmacists, and therapists work together to lead the comprehensive multidisciplinary program known as renal rehabilitation for CKD patients.
What Is Renal Rehabilitation?
A planned, multidimensional strategy called renal rehabilitation (RR) aims to improve renal patients' physical, psychological, and social functioning while lowering morbidity and mortality. Exercise training, nutrition control, hydration management, medication management, education, and counseling for psychological and career issues are only a few of the five main components of RR.
Renal rehabilitation seeks to raise CKD patients' quality of life (QOL). Since persons with CKD benefit greatly from renal rehabilitation programs in terms of physical function and quality of life, the nephrology group felt the need to catch up with cardiology and pulmonary colleagues.
CKD is a global issue for public health. It is linked to decreased exercise capacity, which worsens as renal impairment worsens. Due to the combined consequences of uremic acidosis, protein-energy deficiency, inflammatory cachexia, and a sedentary lifestyle, CKD is linked to poor physical condition and skeletal muscle wastage.
What Is the Indication for Renal Rehabilitation?
Renal rehabilitation (RR) is indicated in various kidney problems. They are:
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Nephritis (inflammation of nephrons) and nephrosis (any kidney disease).
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Chronic kidney illnesses, such as diabetic kidney and polycystic kidney disease.
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Alcoholic renal disease.
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Dialysis treatment.
Many renal disease patients discovered that fitness levels decline for various reasons. These include food limitations, muscle structure modifications, blood flow adjustments, and a lack of exercise. This may result in them feeling sluggish, frail, overweight, and declining quality of life. RR seeks to fix these problems.
How Effective Is Rehabilitation for Dialysis Patients?
A policy statement on exercise therapy for CKD patients was released by Exercise and Sports Science Australia in 2013. It details particular exercise therapy techniques for individuals with end-stage renal disease both during dialysis and on days when dialysis is not being used. For dialysis patients, it suggests up to 180 minutes of aerobic exercise, eight to 12 resistance exercises with a maximum of 60 to 70 % repetitions twice a week, and 10 minutes of flexibility exercises five to seven days a week.
Regarding the length and type of exercise, it has been shown that an intradialytic exercise intervention lasting more than six months considerably impacts exercise tolerance. The meta-analysis revealed that resistance training and aerobic exercise treatment together improved exercise tolerance more than aerobic exercise therapy alone did in clinical investigations. Despite a higher rate of dropouts, a report has also shown that exercise under supervision on days when dialysis is not performed improves exercise tolerance. The connection between these particular techniques and the efficacy of exercise therapy must be considered when performing it.
Exercise significantly improves physical function and quality of life (QOL), two important aspects of renal rehabilitation. In this regard, renal rehabilitation is crucial to attaining the objectives of dialysis therapy.
How Is Rehabilitation Introduced to Dialysis Patients?
Patients with a stable physical state are the focus of exercise therapy. Exercise therapy for dialysis patients should begin with a physical examination, prescribe an appropriate exercise regimen, and offer ongoing support. These are the three critical components of the process. Since cardiovascular problems are common in dialysis patients, it is crucial to quickly determine whether cardiovascular functions and laboratory results, such as serum potassium and anemia, are flexible to exercise treatment before prescribing. The target levels of exercise may be impacted in diabetes individuals by diabetic sequelae such as retinopathy (damage to the retina), neuropathy (damage to one or more nerves), and diabetic foot (complication of diabetes). It is best to quit exercising until the issues are fixed if any significant alterations are noticed.
Prior Assessment:
Participant’s clinical status should be evaluated, subjected to examinations at both rest and exercise stress tests, and given the proper exercise prescriptions before initiating exercise training programs. Exercise is not recommended for people with acute or uncontrolled cardiovascular problems. Exercise is also prohibited for people with blood pressure above 180/100 mmHg, fasting blood glucose levels above 250 mg/dL, and body mass index below 30.0. The rehabilitation program's objectives should also change depending on the patient's health.
Four Elements of an Intervention Using Exercise:
An exercise intervention consists of four essential parts: aerobic exercise, which is exemplified by walking and swimming; resistance training, which is characterized by push-ups and squats; flexibility exercise, which is exemplified by stretching; and balance training, which is exemplified by standing on a single leg.
Exercise Intervention Program:
The principle of "FITT" (frequency, intensity, time, and kind of exercise) should be the foundation of the exercise prescription. On this point, a combination of aerobic exercise (e.g., walking for 30 minutes, five times a week), resistance training (e.g., Thera-band exercise for 10 to 20 minutes with a rating of perceived exertion (RPE) of 13-17), and balance training (e.g., double-/single-leg balancing for five minutes, three to five times a week) is an example of a suitable exercise program for dialysis patients. Dialysis patients have a very high risk of weakness. Because of this, it is best to begin with a low intensity and then adapt it in accordance with the patient's physical state.
What Are the Barriers to Rehabilitation in Kidney Disease?
The main barriers to exercise were the lack of motivational support (family assistance, uplifting, satisfaction, adequate ambitions, and accomplishment) and environmental factors (supervisors, resources, and weather conditions). Physical barriers to exercise included weakness, anemia, and aging. The participants believed that the main obstacle to exercise was poor physical condition brought on by comorbid diseases and CKD-related symptoms (fatigue, joint pain, and shortness of breath). Fear of injury was one of the reported psychological barriers to exercise. The scarcity of knowledge that patients receive from healthcare practitioners regarding the advantages of exercise may contribute to certain worries about exercise.
Conclusion:
In its original form, rehabilitation meant more than just doing exercise therapy; it included using all available therapies and resources to enable kidney disease patients to complete social rehabilitation. It is crucial that the healthcare professionals involved in treating CKD, including doctors, rehabilitation therapists, and diet nutritionists, work together because renal rehabilitation is a comprehensive, multidisciplinary concept for patients with CKD.
