Efficacy of Combined Exercise and Nutritional Intervention for Nondialysis Chronic Kidney Disease: A Systematic...

This systematic review (SR) analyzed the efficacy of combined exercise and nutritional intervention for nondialysis chronic kidney disease (CKD) patients in terms of survival rate, renal function, initiation rate of renal replacement therapy (RRT), muscle mass, physical function including peak volume of oxygen uptake (VO_{2 peak}), and quality of life (QOL).

Database searches were performed of PubMed and Web of Science for English-language articles and Ichushi-Web for Japanese-language articles up to 30 September 2024. Inclusion criteria were randomized controlled trials (RCTs) of adult patients with CKD (stages 3-5), excluding patients undergoing RRT and postkidney transplant, in which the intervention group received combined exercise and nutritional intervention, and the control group received exercise intervention alone, nutritional intervention alone, or no intervention. Cochrane risk-of-bias tool for randomized trials version 2 and Cochrane Review Manager were used to assess the risk of bias in RCTs and meta-analyses, respectively.

Five RCTs involving 339 participants were analyzed. In our meta-analyses, the intervention was associated with a significant improvement in VO_{2 peak} [mean difference = 2.70 mL/kg/min; 95% confidence interval: 1.22, 4.18], but no difference in renal function was observed. However, because the analyzed studies were limited in number and had substantial heterogeneity and risk of bias, the results of our meta-analysis should be regarded as a supplement to our systematic review. The outcomes, including survival rate, initiation rate of RRT, muscle mass, and QOL, were qualitatively summarized due to the small number of studies.

More RCTs are needed in order to provide evidence-based validation of the efficacy of combined exercise and nutritional intervention for patients with nondialysis CKD.