Chronic Renal Failure

Overview of Chronic Renal Failure

Chronic renal failure is due to the loss of the kidney's nephrons, which results in diminished filtration and endocrine functions. Chronic renal failure is assessed by measures of glomerlular filtration rates. Hypertension and diabetes mellitus are the two most common causes of renal failure, with renal failure significantly affecting other systems of the body. Hereditary defects of the kidneys, urinary tract infections, age, and excessive use of analgesics are risk factors for this condition. Individuals with less than 10% of kidney function are in end-stage renal disease and require dialysis. Individuals with renal failure may have anemia, diminished oxygen transport, and decreased ability to maintain blood volumes, which result in fatigue and dyspnea with physical exertion.

Comorbidities to Consider

• Renal failure is associated with hypertension, heart disease, and diabetes mellitus.

Client Examination

Keys to Examination of Clients

• Determine blood urea nitrogen and serum creatinine levels, but changes in these levels do not usually restrict participation in exercise activities.

• Individuals with end-stage renal disease may have low levels of function, which limit the types and amount of baseline testing.

Recommended Baseline Testing of Fitness Levels

• Self-paced walking, treadmill walking, and cycle ergometer tests are the preferred methods.^1,2,3

• Individuals with chronic renal failure usually have hypertension and heart disease, which are significant precautions for exercise programs.

Exercise Prescription

Type: Walking, treadmill walking, cycle ergometry

Intensity: Low to moderate levels

Duration: Start at 10–15 minutes

Frequency: Three times per week

Getting Started

Walking programs and cycle ergometers are the best modes of exercise for clients with renal failure. Those receiving dialysis may choose to exercise on dialysis or on non-dialysis days. Clients taking dialysis can perform exercise using a treadmill, cycle ergometer, or bed/chair exercises. Greater improvements in physical and cardiopulmonary function have been found for those who exercise on non-dialysis days, but exercise during dialysis can be an effective and more efficient means for ensuring adherence to the exercise program.^4,5

Recommended levels of aerobic activities are within 60% to 70% of maximum heart rate, with frequent assessment of blood pressure and perceived exertion.⁵ Exercise programs should consist of a long warm-up followed by a consistent level of effort during aerobic and strengthening activities. A cool-down period is also important to allow for return of fluid distribution and blood pressure. Clients should learn to assess their exercise intensity level primarily by their rate of perceived exertion and not by heart rate.⁶ Lightheadedness, dizziness, pain, and dyspnea are indicators that exercise needs to be stopped and the client reassessed.³ Progressions of ...