Exercising with advanced chronic kidney disease (CKD)

Dear Friend,

recently one of my long term clients and dear friends started dialysis after years of chronic kidney disease (CKD) as it moved from stage 3 to 4 and finally reached stage 5 which called for aggressive treatment and dialysis.

Today's blog is trying to provide some insights into exercising with advanced chronic kidney disease and dialysis.

Did you know that one in seven adult Americans suffers from chronic kidney disease?

 http://www.physiciansweekly.com/ckd-incidence-prevalence/

The presence of CKD should be established through presence of kidney damage and level of kidney function measured by glomerular filtration rate (GFR). During stages 3 and 4 your kidneys are still able to remove some waste and excess fluids from your blood  and treatment is mostly focused on keeping your body nourished and treating other diseases contributing to the kidney disease. In addition your doctor will closely monitor kidney function to quickly intervene through medication and diet when necessary. Diet recommendations for patients wit CKD change with the amount of kidney function remaining, requiring adjustments in intake of protein, calories and other nutrients.

The most common causes of reaching the end-stage of this disease is diabetes mellitus. If diagnosed with diabetes make sure you watch your blood glucose levels and follow your treatment (insulin and other medications) strictly to prevent renal failure. Another cause for moving on to dialysis is hypertension as it damages the small blood vessels inside the kidneys. Controlling blood pressure by way of medication (often two different types) and reduced sodium intake is essential when trying to reduce the risk of further kidney damage.

Healthy kidneys produce the hormone erythropoietin also known as EPO which stimulates the bone marrow to make red blood cells, responsible for oxygen transport in the blood. Patients with chronic kidney disease do not produce enough EPO and often suffer from Anemia causing fatigue and paleness. Severe Anemia also places undue stress on the heart causing a greater risk for heart failure in patients with chronic kidney disease. Treatment options include EPO injections and iron supplements as EPO treatment is only successful if blood iron levels are sufficient.

Other problems caused by kidney disease effect bone health as phosphorous levels often increase and Calcium and Vitamin D levels decrease. Periodic bone density check ups are therefore warranted.

Knowing about the problems that chronic kidney disease can cause and being aware of possible other contributing diseases is helpful when starting and deciding on an exercise program. Many dialysis patients believe that they can't exercise any longer. The opposite is the truth. A regular exercise program has shown to be very beneficial to both, patients with chronic kidney disease even when undergoing dialysis. A regular exercise program yields the same benefits as it does for healthy individuals including but not limited to:

• increased energy and endurance

• improved physical function and activities of daily living

• greater muscular strength and counterbalance dialysis associated muscular atrophy

• lowering blood lipids

• controlling blood pressure

• improving insulin resistance

• managing body weight

• greater sleep quality

• enhanced mental outlook

Exercising is extremely important for patients with CKD. Studies have shown that physically active individuals predialytic, on hemodialysis and after kidney transplant increase their overall quality of life and improve the outcome of renal disease.
Before starting any exercise program patients with CKD should consult with their physicians and discuss safe forms of exercise and possible risk factors and contra indications. Your nephrologist is aware how much, how often and what types of exercise are beneficial in your particular situation. In case a trainer or Physical Therapist is involved in your effort to exercise I strongly recommend a consult between the fitness expert and your physician ensuring successful and safe work-outs.

When starting an exercise program choose activities that are enjoyable as it increases the chances for better compliance. If you are a novice to exercising start out and progress work-outs slowly. Exercises that have proven to be of great benefit to patients include aerobic activities, such as walking, jogging, cycling, skiing, dancing and swimming. Try to work up slowly to 3-4 weekly sessions of 30 minutes or more. Chose a workout intensity that allows you to keep up a conversation without shortness of breath. Avoid exhaustion.

In addition to aerobic activities CDK patients should get involved in a regular resistance training program that helps increase lean muscle mass and strength. Work out loads should be light to moderate and focus on repetitions rather than load increases. Work-out intensities should be kept moderate to avoid excessive muscle soreness and fatigue. In order to be successful try two or three weekly sessions, strengthening all major muscle groups.

If exercising outdoors avoid the hottest hours of the day; avoid big meals right before exercising, and don't place your work-outs too close to bed time as it might interfere with the ability to go to sleep. Stop the work-out if you experience chest pain, excessive tiredness or shortness of breath. Do not exercise if you have a fever and changed your dialysis or medicine schedule before consulting with your nephrologist.

Conclusion: Not only can CDK patients exercise at any stage of the disease, it is encouraged and vital to the emotional and physical well-being, overall quality of life, and the outcome of the disease. The potential risk of physical activity can be reduced by medical evaluation, risk stratification, careful supervision, and education.

As always, your comments and questions are much appreciated.

In good health,
Hartmut

Sources:
http://www.dciinc.org
http://nwkidney.org
http://www.renalresource.com
http://www.ncbi.nlm.nih.gov/pubmed/15742304
http://www.kidney.org
http://www.davita.com
Physical Exercise in Patients with Severe Kidney Disease
G.C. Kosmadakis, A. Bevington,  A.C. Smith a E.L. Clapp, J.L. Viana, N.C. Bishop, J. Feehall http://www.kidney.org/atoz/pdf/nutri_chronic.pdf
http://www.kidney.org/professionals/kdoqi/guidelines_ckd/p4_class_g1.htm
http://www.kidney.org/kidneydisease/aboutckd.cfm
http://www.physiciansweekly.com/ckd-incidence-prevalence/