Answer. Exercise is a very important part of any program to stay healthy with chronic kidney disease.

Cardiovascular disease is the major cause of morbidity (causing other diseases and healthcare problems) and mortality in kidney disease and dialysis patients. Endurance exercise training (running, swimming, bicycling) has been shown to improve HDL cholesterol (good cholesterol) in the general population.

Cardiovascular fitness is a predictor of mortality. Of course, patients who exercise regularly should have their doctor's clearance. Patients with chronic kidney disease need only to look to the sports pages for inspiration. In 1999, Sean Elliott led the San Antonio Spurs to win four out of five playoff games over the New York Knicks for the NBA National Championship. A few weeks later, he underwent a kidney transplant. It is evident that he had chronic kidney disease during the most illustrious time in his career, never missed a game and scored double digits in most games!

Chronic kidney disease (CKD) can be associated with muscle wasting but this may be related to decreased nutrition and inactivity. Although it is recommended that patients with chronic kidney disease limit their intake of protein (or at least not increase protein consumption), there is controversy as to how much. In the later stages of CKD, patients lose their appetite and may experience muscle wasting as a secondary complication of decreased kidney function and metabolic acidosis. It has been shown that resistance training (weights and exercise machines) will increase muscle mass and help patients on a protein restriction better utilize what protein they do ingest.

One of the key successes of a chronic kidney disease program is that as a result of patient awareness and education, a decision regarding modality (treatment method) of therapy can be made well in advance of requiring dialysis. In those who choose hemodialysis, it is advised that an arteriovenous fistula be created. These are superior to bridge grafts, but require a longer period of time to mature - at least two to three months and even longer in some patients. In order to mature and become ready for use, one must perform regular resistance arm exercises. In addition, patients with a chronic disease require frequent phlebotomies (blood draws for laboratory tests). A trip to the fitness club will demonstrate that resistance arm exercises will help build larger veins along with larger muscles. Large veins make the trip to the blood drawing station more bearable.

Above all, exercise makes one feel good. This is true regardless of the underlying condition. Dialysis patients who are put on a regular exercise program score higher on Quality of Life tests. Patients with heart failure also benefit from cardiac rehabilitation. In the past, poor nutrition and anemia decreased exercise capacity. Now, we are aware of both of these problems and can focus on avoiding them.  

Answer provided by Stephen Z. Fadem, MD, FACP. Dr. Fadem is a practicing nephrologist in Houston, TX. He also serves as a member of the AAKP Medical Advisory Board.

References

1. Castaneda C, Gordon PL, Uhlin KL, Levey AS, Kehayias JJ, Dwyer JT, Fielding RA, Roubenoff R, Singh MF. Resistance training to counteract the catabolism of a low-protein diet in patients with chronic renal insufficiency. A randomized, controlled trial. Ann Intern Med  2001 Dec 4;135(11):965-76.

2. Cody J, Daly C, Campbell M, Donaldson C, Grant A, Khan I, Pennington S, Vale L, Wallace S, MacLeod A. Recombinant human erythropoietin for chronic renal failure anaemia in pre-dialysis patients. Cochrane Database Syst Rev  2001;(4):CD003266.

3. Franssen FM, Wouters EF, Schols AM. The contribution of starvation, deconditioning and aging to the observed alterations in peripheral skeletal muscle in chronic organ diseases.  Clin Nutr  2002 Feb;21(1):1-14.

4. Iborra Molto C, Pico Vicent L, Montiel Castillo A, Clemente Ramon F. Quality of life and exercise in renal disease. EDTNA ERCA J  2000 Jan-Mar;26(1):38-40.

5. Kouidi EJ. Central and peripheral adaptations to physical training in patients with end-stage renal disease. Sports Med  2001;31(9):651-65.

6. Talbot LA, Morrell CH, Metter EJ, Fleg JL. Comparison of cardiorespiratory fitness versus leisure time physical activity as predictors of coronary events in men aged < or = 65 years and > 65 years. Am J Cardiol  2002 May 15;89(10):1187-92.

The American Association of Kidney Patients presents Ask the Doctor, an opportunity for readers to submit kidney related health questions to healthcare professionals who specialize in an area of concern. The answers are not to be construed as a diagnosis and therefore, alterations in current healthcare should not occur until the patient’s physician is consulted.

This article originally appeared in the August 2002 issue of Kidney Beginnings: The Magazine, Vol. 1, No. 1.

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