Physical Therapy Considerations for Chronic Kidney Disease and Secondary Sarcopenia

Abstract

Chronic kidney disease (CKD) is a progressive condition that may negatively affect musculoskeletal health. These comorbidities may include malnutrition, osteoporosis, and decreased lean body mass. Secondary sarcopenia due to CKD may be associated with mobility limitations and elevated fall risk. Physical therapists are well-positioned among the health care team to screen for secondary sarcopenia in those with CKD and for the treatment of musculoskeletal comorbid conditions that may affect functional performance. Given the consequences of both low muscle mass and low bone mineral density, appropriate and timely physical therapy is important for fall risk assessment and intervention to minimize the susceptibility to bone fracture. While strength training has been studied less frequently than aerobic training for the management of secondary CKD conditions, evidence suggests that this patient population benefits from participation in strength training programs. However, the provision of a formal exercise prescription by a health care professional, along with formal implementation of an exercise program, may need to be more fully integrated into the standard plan of care for individuals with CKD.

Sarcopenia in Chronic Kidney Disease: A Scoping Review of Prevalence, Risk Factors, Association with Outcomes, and Treatment

“…More recently, in 2018, a meta-analysis of 11 RCT (362 patients) in CKD stages 3–4 reported an increased exercise tolerance with an average of a 35-week aerobic training program as compared to standard care [ 114 ]. The prescription of exercise in CKD patients is still the most corroborated intervention and could be effective in preventing and reversing sarcopenia, thus it should be a considered for all patients [ 58 , 115 , 116 ].…”

Diagnosis and treatment of osteoporosis in patients with chronic kidney disease

“…Bei CKD-Patienten [120][121][122] wird zwar nicht explizit eine direkte osteoanabole Wirkung, jedoch eine Verbesserung der Kraft und Muskelmasse durch Krafttraining beschrieben. Zusätzlich scheint es positiv auf Sturz-und Frakturrisiko zu wirken [123].…”

Effect of exercise in obese diabetic patients with chronic kidney disease

“…in more advanced stages, the risk of having a frailty phenotype has been greatly observed. The phenotype is associated with a 2.5-fold increase in death and with the need to start dialysis [17,18].…”