New Approaches in Nutritional Management, Physical Exercise for CKD and Dialysis Patients

Dear Colleagues,

Chronic kidney disease (CKD) represents one of the most prominent causes of death and morbidity in the 21^st century, mostly due to the increase in the associated cardiovascular risk factors, such as diabetes mellitus and hypertension. Currently, around 3 million people worldwide are receiving dialysis due to CKD progression to the end stage of kidney disease (ESKD), with a consequent increased mortality risk due to cardiovascular events and the undermined quality of life that the dialytic process entails. In recent years, the concept of renal rehabilitation has become widely known in the therapeutic paradigm of patients with CKD, consisting of a long-term comprehensive program including exercise therapy, diet, pharmacological treatment and psychological support for these patients.

Nutrition is a big part of the renal rehabilitation programme, as the prevalence of malnutrition in CKD may vary from 12% to 80%. Malnutrition not only refers to malnourishment, but also any nutrient imbalance, encompassing circumstances like overweight and obesity, or even the chronic inflammatory condition of the adipose tissue or its abnormal distribution (adiposopathy). Certainly, interventions for weight loss may generate debate among patients with dialysis due to the phenomenon of ‘reverse epidemiology’. However, nutritional interventions in patients with ESKD are associated with a slower progression of the disease due to multifactorial mechanisms, such as a reduction in metabolic acidosis and hyperkalaemia, an increase in the glomerular filtration rate and an improvement in the gut microbial profile.

On the other hand, several programmes have been implemented in the last years to promote physical exercise in patients with dialysis, revealing an improvement in the muscular strength, aerobic capacity, left ventricular systolic function, arterial compliance and quality of life. The benefits from exercise in patients with CKD seem to be physiologically supported by a reduction in oxidative stress and inflammatory markers, with a normalization of the lipid and glycaemic profile.

From a pharmacological point of view, new drugs like sodium–glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA), which have produced a revolution in the treatment of patients with type 2 diabetes, are also making a breakthrough in the management of diabetic kidney disease and its wide range of complications. SGLT2i and GLP-1RA have been proven to reduce the progression of renal damage in patients with diabetes via mechanisms that go beyond their glycaemic-lowering effects and caloric intake reduction. Apparently, these drugs combat the systemic inflammation and oxidative stress in patients with diabetic kidney disease, thereby providing these patients with cardiovascular benefits.

The goal of this Special Issue is to assemble the latest evidence on renal rehabilitation-focused interventions for patients with CKD, from a nutritional and physical exercise point of view. Original research articles and reviews (narrative, systematic and metanalysis) addressing the effects of these approaches on the cardiovascular and renal functions, or the overall quality of life of patients with CKD, will be welcomed. 

Prof. Dr. Luis D’Marco
Dr. Ana Checa Ros
Guest Editors

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• nutrition
• diet
• malnutrition
• exercise
• chronic kidney disease
• CKD
• renal
• dialysis