Executive summary of the clinical practice guideline for renal rehabilitation 2026: systematic reviews and recommendations of exercise therapies, nutritional therapies, and multidisciplinary care in patients with chronic kidney diseases
Year: 2026
Type: review
Abstract: The concept of renal rehabilitation has become increasingly recognized among physicians, nurses, pharmacists, dietitians, physical therapists, occupational therapists, other healthcare professionals, and patients. In 2018, the Japanese Society of Renal Rehabilitation published the first clinical practice guideline for renal rehabilitation. Since then, evidence on exercise therapy, nutritional therapy, multidisciplinary care, and lifestyle modifications in patients with chronic kidney disease (CKD) has increased. The 2026 revision covers the full CKD spectrum, including non-dialysis-dependent CKD, hemodialysis, peritoneal dialysis, and kidney transplantation. Systematic reviews were conducted with predefined outcomes, including all-cause mortality, cardiovascular events, physical function and physical activity, health-related quality of life, nutritional and inflammatory markers, dialysis adequacy, and adverse events. A major feature of this revision was the addition of new domains. New systematic reviews were conducted on physical therapist-led interventions, multidisciplinary care involving nurses, and combined exercise and nutritional interventions. A total of 12 recommendations were developed across the main domains of renal rehabilitation: non-dialysis-dependent CKD, dialysis therapy, kidney transplantation, physical therapy, multidisciplinary care and nursing, and nutritional therapy. Recommendation grades were determined by consensus among patient representatives and professionals from various disciplines. Although the certainty of evidence for hard outcomes remains limited, consistent benefits were observed for physical function, quality of life, and other patient-centered outcomes. This revised guideline positions renal rehabilitation as a core component of CKD care and emphasizes multidisciplinary collaboration and sustained, patient-centered implementation throughout the disease course.
Source: Renal Replacement Therapy
Authors: Junichi Hoshino, Tadashi Sofue, Toshiaki Usui, Susumu Toda, Hiroo Kawarazaki, Kiyotaka Uchiyama, Tsutomu Sakurada, Hideyo Oguchi, Masahiko Yazawa, Ryota Matsuzawa, Masakazu Saitoh, Takahiro Ohashi, Shiho Kosaka, Etsuko Doi, Michihiro Hosojima, Naohiko Fujii, Ichiei Narita, Kunihiro Yamagata, Yugo Shibagaki, Shinichi Tokura, Takeshi Shukunobe, Akiko Uchida, Hidetaka Wakabayashi, Masahide Kondo, Systematic Review Members, Naotaka Ikeda, Shun Ishibashi, Naoto Usui, Daisuke Uchida, Chiharu Uno, Masatomo Ogata, Shintaro Ochiai, Yuhei Otobe, Hideyuki Kabasawa, Ayaka Kamata, Haruna Kugai, Toshiki Kutsuna, Yuki Kunitsu, Shigeki Kojima, Sho Kojima, Kenichi Kono, Ryu Kobayashi, Nobuyuki Shirai, Yuta Suzuki, Noriyuki Kounoue, Yohei Tsuchida, Maho Terashita, Kotaro Hitoshi, Kenta Torigoe, Shuhei Nakajima, Shinta Nishioka, Masatoshi Nishimoto, Akihisa Hattori, Takuya Harada, Akihito Hishikawa, Yu Honda, Shota Matsufuji, Hiromasa Miyake, Hiroki Yabe, Shohei Yamada, Shun Tonomura, Collaborators, Hiroki Nishiwaki, Kokichi Morimoto, Yuki Ohara, Yasushi Tsujimoto, Norio Watanabe, Izumi Endo, Yu Nagaoka, Yuka Konishi, Naoko Mizushima, Yasuhiko Shiroyama, Yoshihiro Ishihara, Soichi Kono
Institutions: Tokyo Women's Medical University, Kagawa University, University of Tsukuba, Teikyo University Hospital, Mizonokuchi, International University of Health and Welfare, St. Marianna University School of Medicine, Toho University, Yokohama General Hospital, Hyogo Medical University, Juntendo University, Kansai Medical University, Toranomon Hospital, Fukushima Medical University, Hyogo Prefectural Nishinomiya Hospital, Niigata University of Health and Welfare
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7213762618