Beyond Kidney Function: Advancing Physiotherapy in Chronic Kidney Disease Care

Abstract

Chronic kidney disease (CKD) is a progressive systemic condition whose impact extends beyond the declining kidney function. As the disease progresses, patients may experience reductions in physical activity, exercise capacity, muscle strength, mobility, and quality of life. These challenges become increasingly complex among patients receiving hemodialysis because of comorbidities, fatigue, deconditioning, and prolonged periods of low physical activity. The 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guideline recognizes physical activity as an important component of CKD management and recommends moderate-intensity physical activity according to the patient's cardiovascular and physical tolerance. However, translating physical activity recommendations into safe, individualized, measurable, and function-oriented programs requires specific clinical expertise and knowledge. In this context, physiotherapy plays a strategic role in functional assessment, exercise prescription, monitoring of physiological responses, intradialytic rehabilitation, and management of activity limitations. Current evidence indicates that aerobic, resistance, combined, and intradialytic exercises can benefit the physical capacity and quality of life of patients undergoing dialysis. This editorial proposes a shift from a predominantly kidney-centered approach to a function-centered model of kidney care, positioning physiotherapy as an integral component of multidisciplinary kidney care. CKD care should not focus solely on survival but also on patients' ability to move, remain active, participate, maintain independence, and live meaningful lives.