Effectiveness and Safety of Exercise Therapy for Non-Dialysis-Dependent Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Background Chronic kidney disease (CKD) represents a significant global public health concern, impairing patients' quality of life, functional status, and increases overall morbidity and mortality. Although exercise therapy has demonstrated potential benefits for the management of non-dialysis-dependent CKD (NDD-CKD), the evidence base remains to be consolidated. Therefore, this review aims to evaluate the effectiveness and the safety of exercise intervention on NDD-CKD patients by integrating the available high-quality studies. Methods A systematic literature search was conducted using PubMed and Ichushi-Web, a database of Japanese medical literature, up to February 29, 2024. We pooled only randomized controlled trials (RCTs) comparing exercise intervention with usual care, and conducted meta-analyses based on a random effects inverse variance model. Results A systematic literature search identified 9131 articles, and after screening, 19 RCTs were included for qualitative evaluation. We included 15 RCTs in the quantitative meta-analysis. No RCTs investigated the effects of exercise on all-cause mortality or hospitalization. The meta-analysis of kidney function, including the estimated glomerular filtration rate using serum creatinine (eGFRcr) and the degree of albuminuria/proteinuria showed no significant difference between the intervention and control groups. However, a pooled analysis on eGFRcr suggested an attenuated decline in the intervention group (mean difference: 0.96 mL/min/1.73 m ² ; 95% CI, − 1.25 to 3.17). In addition, exercise intervention led to significant improvements in several secondary outcomes: exercise capacity (VO ₂ peak increased by 2.13 mL/kg/min), ambulatory function (6-minute walk distance increased by 51.16 m), and Health-Related Quality of Life (HR-QoL) (significant improvements across multiple subscales of KDQOL, as well as SF-12/36 Physical and Mental Component Summaries). No significant increase in the incidence of adverse events, such as musculoskeletal injuries, was observed in the intervention groups. Conclusions Exercise therapy is a safe and effective strategy for improving exercise capacity, ambulatory function, and HR-QoL in patients with NDD-CKD. These findings support its incorporation into routine clinical care.