{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:52:10Z","timestamp":1792788730171,"version":"4.5.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","funder":[{"name":"Japan Society for the Promotion of Science","award":["24K14335"],"award-info":[{"award-number":["24K14335"]}],"id":[{"id":"https:\/\/ror.org\/00hhkn466","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Kidney Foundation, Japan"},{"name":"Japanese Society of Renal Rehabilitation"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2026,10]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Intradialytic renal rehabilitation was associated with higher 3-year survival in patients on maintenance hemodialysis.<\/jats:p>\n <\/jats:list-item>\n \n This association was directionally consistent after multivariable adjustment and propensity score matching.<\/jats:p>\n <\/jats:list-item>\n \n The association seemed stronger in men with severe frailty; no rehabilitation-related adverse events were reported.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We evaluated 708 adult outpatients on dialysis (age, 69.8\u00b111.2 years; men, 59%; and Clinical Frailty Scale \u22656, 13%) at ten institutions across Japan in January 2021 who were retrospectively assessed over a 3-year period, including 228 patients who received intradialytic renal rehabilitation, defined as supervised intradialytic exercise instruction plus nutritional and lifestyle guidance (\u22651 session\/wk for\u22651 month), and 480 who did not receive this intervention. Cox regression models and propensity score matching were used to compare 3-year mortality after adjustment for the Clinical Frailty Scale, comorbidities, laboratory data, and other baseline characteristics.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n During the follow-up, deaths were observed in 14.9% of the rehabilitation group and 23.1% of the nonrehabilitation group (\n P<\/jats:italic>\n = 0.01). Three-year survival was higher with rehabilitation (84.6% versus 75.6%,\n P<\/jats:italic>\n = 0.007), particularly among men and those with severe frailty. In Cox models, renal rehabilitation was consistently associated with lower mortality (crude hazard ratio [HR], 0.59 [95% confidence interval (CI), 0.40 to 0.87]; adjusted HR 0.66 [0.44 to 1.00]). After propensity score matching, the association remained directionally similar (HR, 0.65 [0.40 to 1.05]). Sex-stratified analyses suggested a stronger association among men (adjusted HR, 0.49 [0.27 to 0.89]) than among women (adjusted HR, 0.98 [0.54 to 1.77]), although the formal test for interaction was not statistically significant (\n P<\/jats:italic>\n for interaction = 0.13). Patients meeting exercise-habit criteria (\u22652 sessions\/wk, \u226530 minutes for \u22651 year) also showed better survival relative to the nonexercise-habit group (adjusted HR 0.60 [0.37 to 0.96],\n P<\/jats:italic>\n = 0.03). No adverse events related to rehabilitation were reported.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Intradialytic renal rehabilitation may be associated with better survival in patients on maintenance hemodialysis, particularly in men and in those with severe frailty.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.0000001133","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T16:01:23Z","timestamp":1784131283000},"page":"1753-1761","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Intradialytic Renal Rehabilitation and Mortality"],"prefix":"10.2215","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0444-101X","authenticated-orcid":false,"given":"Junichi","family":"Hoshino","sequence":"first","affiliation":[{"name":"Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3464-6016","authenticated-orcid":false,"given":"Keisuke","family":"Kida","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, St. Marianna University School of Medicine, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1168-2644","authenticated-orcid":false,"given":"Shizuka","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8716-4625","authenticated-orcid":false,"given":"Kenichi","family":"Kono","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Faculty of Health Science at Fukuoka, International University of Health and Welfare, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4165-7626","authenticated-orcid":false,"given":"Ryota","family":"Matsuzawa","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1299-6231","authenticated-orcid":false,"given":"Yuhei","family":"Otobe","sequence":"additional","affiliation":[{"name":"Graduate School of Rehabilitation Science, Osaka Metropolitan University, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6001-578X","authenticated-orcid":false,"given":"Keisei","family":"Kosaki","sequence":"additional","affiliation":[{"name":"Division of Internal Sports Medicine, Institute of Health and Sports Sciences, University of Tsukuba, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiko","family":"Yazawa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yokohama General Hospital, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Tsuchida","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Shinrakuen Hospital, Niigata, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8192-4891","authenticated-orcid":false,"given":"Toshiaki","family":"Usui","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Institute of Medicine, University of Tsukuba, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuta","family":"Ouchi","sequence":"additional","affiliation":[{"name":"Aozora Clinic, Miyagi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7365-7685","authenticated-orcid":false,"given":"Hiroki","family":"Nishiwaki","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Showa Medical University Fujigaoka Hospital, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0420-5583","authenticated-orcid":false,"given":"Takeshi","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Institute of Clinical Epidemiology, Showa Medical University, Tokyo, Japan"},{"name":"Departments of Nephrology and Hygiene, Public Health, and Preventive Medicine, Graduate School of Medicine, Showa Medical University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6411-8599","authenticated-orcid":false,"given":"Naohiko","family":"Fujii","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1136-8532","authenticated-orcid":false,"given":"Tadashi","family":"Sofue","sequence":"additional","affiliation":[{"name":"Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7407-0410","authenticated-orcid":false,"given":"Kunihiro","family":"Yamagata","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Institute of Medicine, University of Tsukuba, Ibaraki, Japan"},{"name":"Division of Preventive and Sports 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