Physiotherapy in Chronic Hemodialysis Patients. Recommendations of the Expert Committee of the Rehabilitation Section at the Polish Society of Nephrology

Abstract

Background: The introduction of renal replacement therapy and its dynamic development contributes to the constant increase in the number of haemodialysis patients. Extending the life of patients with chronic kidney disease (CKD) is no longer the only objective of the medical community. Recently, measures have been initiated to improve quality of life among patients, which is largely influenced by physical functioning, the ability to undertake physical activity and functional independence. Despite the initiatives carried out for many years in the implementation of various regular physical activity forms among people with CKD in Poland, physiotherapy is still not an element of standard care for nephrological patients. In practice, it is mainly based on periodically implemented research projects, as well as scientific meetings devoted to this subject in groups comprising nephrol-ogists and physiotherapists. Despite numerous scientific reports on the safety and effectiveness of undertaking physical activity by end-stage renal disease (ESRD) patients, there are still beliefs in the medical community perceiving this disease as a con-traindication to physical training. Objective: The aim of the recommendation is to present current guidelines for the implementation and conduct of physiotherapy in chronic haemodialysis patients. The results should promote greater support for this group of patients, both at dialysis centres, nephrology and rehabilitation departments. Data sources: The aim of the study was based on reviewing 140 items of literature from 1961 to 2022, constituting the basis for formulating the recommendations in question. Summary: The many health benefits of adequate physical activity among patients on chronic dialysis have been confirmed in many interventional and observational studies. Over 90 randomised studies have provided a fundament for developing recommendations of many international societies: British, Japanese and European. The expert group preparing these recommenda-tions, using the DELPHI method, expressed opinions on qualifying for exercise, prescribing and supervising exercise by phys-iotherapists. Further action is needed by all stakeholders: doctors, physiotherapists, patient organisations, owners of dialysis stations and payers to implement supervised, structured exercise programmes for chronic dialysis patients.