Kidney Week

Abstract: SA-PO0913

Intradialytic Renal Rehabilitation and Mortality: Results from the Registry of Active Renal Rehabilitation in Dialysis Patients (REVEAL-D)

Session Information

• Health Maintenance, Nutrition, and Metabolism
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1500 Health Maintenance, Nutrition, and Metabolism

Authors

• Hoshino, Junichi, Tokyo Joshi Ika Daigaku, Shinjuku, Tokyo, Japan

Junichi Hoshino, MD, PhD, MPH

• Kida, Keisuke, Sei Marianna Ika Daigaku, Kawasaki, Kanagawa Prefecture, Japan

Keisuke Kida, DrMed, DrPH

• Kobayashi, Shizuka, Tokyo Joshi Ika Daigaku, Shinjuku, Tokyo, Japan

Shizuka Kobayashi, MD

• Kono, Kenichi, Kokusai Iryo Fukushi Daigaku Kohokai Group, Fukuoka, Fukuoka, Japan

Kenichi Kono, PhD

• Matsuzawa, Ryota, Hyogo Ika Daigaku, Nishinomiya, Hyogo Prefecture, Japan

Ryota Matsuzawa, PhD

• Otobe, Yuhei, Osaka Koritsu Daigaku, Osaka, Osaka Prefecture, Japan

Yuhei Otobe, PhD

• Kosaki, Keisei, Tsukuba Daigaku, Tsukuba, Ibaraki Prefecture, Japan

Keisei Kosaki, PhD

• Yazawa, Masahiko, Sei Marianna Ika Daigaku, Kawasaki, Kanagawa Prefecture, Japan

Masahiko Yazawa, MD, PhD

• Tsuchida, Yohei, Shinrakuen Byoin, Niigata, Niigata Prefecture, Japan

Yohei Tsuchida, DrMed, DrPH

• Usui, Toshiaki, Tsukuba Daigaku, Tsukuba, Ibaraki Prefecture, Japan

Toshiaki Usui, MD, PhD

• Ouchi, Yuta Fujikura, Aozora Clinic, Miyagi, Japan

Yuta Fujikura Ouchi, MD, PhD

• Nishiwaki, Hiroki, Showa Daigaku Fujigaoka Byoin, Yokohama, Kanagawa Prefecture, Japan

Hiroki Nishiwaki, MD, PhD, MPH

• Hasegawa, Takeshi, Showa Daigaku Fujigaoka Byoin, Yokohama, Kanagawa Prefecture, Japan

Takeshi Hasegawa, MD, PhD, MPH

• Fujii, Naohiko, Hyogo Kenritsu Nishinomiya Byoin, Nishinomiya, Hyogo Prefecture, Japan

Naohiko Fujii, MD, PhD

• Sofue, Tadashi, Kagawa Daigaku, Takamatsu, Kagawa Prefecture, Japan

Tadashi Sofue, MD, PhD

• Yamagata, Kunihiro, Tsukuba Daigaku, Tsukuba, Ibaraki Prefecture, Japan

Kunihiro Yamagata, MD, PhD

• Shibagaki, Yugo, Sei Marianna Ika Daigaku, Kawasaki, Kanagawa Prefecture, Japan

Yugo Shibagaki, MD

• Narita, Ichiei, Niigata Iryo Fukushi Daigaku, Niigata, Niigata Prefecture, Japan

Ichiei Narita, MD, PhD

Group or Team Name

• The REVEAL-D

Background

Frailty and sarcopenia are increasingly common among patients undergoing maintenance hemodialysis, and Japan has recently introduced insurance reimbursement for intradialytic renal rehabilitation, a supervised intradialytic exercise instruction plus nutritional and lifestyle guidance. However, the survival benefit has not been fully evaluated.

Methods

We enrolled 708 adult dialysis outpatients (age, 69.8±11.2; men, 59%; and Clinical Frailty Scale≥6, 13%) at 10 institutions in January 2021 and retrospectively followed them for 3 years, including 228 patients who received intradialytic renal rehabilitation, defined as supervised intradialytic exercise instruction plus nutritional and lifestyle guidance (≥1 session/week for≥1 month), and 480 who did not. To compare three-year mortality, Cox regression models, and propensity score (PS) matching were applied to adjust the Clinical Frailty Scale, comorbidities, laboratory data and other backgrounds.

Results

During the follow-up, deaths were observed in 14.9% of the rehabilitation group and 23.1% of the non-rehabilitation group (p=0.01). Three-year survival was higher with rehabilitation (85.0% vs 76.5%, p = 0.008), especially in those with severe frailty. In unadjusted and adjusted Cox models, renal rehabilitation was consistently associated with lower mortality (crude HR 0.60 [95% CI, 0.41–0.88]; adjusted HR 0.67 [0.44–1.01]). After PS matching, better survival persisted (HR 0.65 [0.40–1.05]). Sex-stratified analyses suggested a stronger association among men (e.g., adjusted HR 0.50 [0.27–0.90]), whereas no significant association was observed in women. Patients meeting exercise-habit criteria (≥2 sessions/week, ≥30 min for ≥1 year) also showed better survival (p = 0.03). No adverse events related to rehabilitation were reported.

Conclusion

Intradialytic renal rehabilitation was associated with better survival in maintenance hemodialysis patients, particularly in men and in those with severe frailty.

Acknowledgment

We would like to express our sincerest gratitude to all the members of the scientific committee of the Japanese Society for Renal Rehabilitation and all the members in the dialysis centers collaborating with this study.

Funding

• Government Support – Non-U.S.