[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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This review summarizes the key updates of the revised Clinical Practice Guidelines for Renal Rehabilitation, reflecting the growing need for comprehensive and sustainable care for patients with chronic kidney disease（CKD）in an aging society. Since the first guideline was published in 2018, substantial new evidence has accumulated, prompting a major revision conducted in accordance with the Minds Clinical Practice Guideline Development Manual. 　The revised guideline covers the entire CKD spectrum, including non—dialysis CKD, hemodialysis and peritoneal dialysis, and kidney transplantation. Systematic reviews were performed with clearly predefined outcomes, including all—cause mortality, cardiovascular events, physical function and physical activity, health—related quality of life, nutritional and inflammatory markers, dialysis efficiency, and adverse events. Compared with the previous edition, a markedly larger number of randomized controlled trials were included, particularly in the dialysis population. 　A distinctive feature of this revision is the inclusion of new domains. Systematic reviews were newly conducted on physical therapist—led interventions, nursing—led multidisciplinary care, and combined exercise and nutritional interventions. In addition, new chapters focusing on social welfare and behavior change were established, emphasizing renal rehabilitation not only as a prescribed intervention but as a program requiring continuous implementation and long—term support. 　Although the certainty of evidence for hard outcomes remains limited, consistent benefits were observed in physical function, quality of life, and other patient—centered outcomes. This revised guideline positions renal rehabilitation as a core component of CKD care, highlighting the importance of multidisciplinary collaboration and sustained, patient—centered implementation across the disease course.

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　Background and Objective：There is no consensus on the effectiveness of exercise in preventing the onset and progression of chronic kidney disease（CKD）. Based on the concept of“Exercise is medicine （EIM）”, we conducted a Scoping review focusing on human studies to determine whether exercise— induced secretion of Exerkines has a renal protective effect and the underlying mechanism. 　Methods：A literature search was conducted in PubMed in accordance with PRISMA 2020. Studies were selected that included adults, and patients with end—stage renal disease or dialysis were excluded. 　Results and Discussion：Two papers were found that examined the renal protective effects of exercise, revealing that the higher the irisin secretion, the lower the risk of developing and progressing CKD. Furthermore, research reports indicated that irisin, due to its anti—inflammatory properties, is effective in renal protection. Other exercises, such as IL—6, TGF—β, adiponectin, and FGF, may also be involved in renal protection. Further evidence is needed regarding the relationship between CKD prevention and exercise, but there is a high possibility that exercise can contribute to CKD prevention.

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【Background】Exercise function declines with chronic kidney disease（CKD）progression, making exercise therapy and physical activity（PA）improvement crucial. 【Objective】This study surveys the landscape of research on exercise therapy and PA promotion for patients with CKD stages G4—5, summarizes the evidence on intervention efficacy, and identifies gaps in the literature. 【Methods】Literature search was conducted using four databases following PRISMA—ScR guidelines, with evaluation by two independent reviewers. 【Results】Analysis of 10 studies（9 exercise therapy, 1 PA）showed moderate—intensity exercise therapy maintained ／ improved muscle strength and exercise tolerance, while moderate to high—intensity PA reduced mortality rates. 【Conclusion】This review suggests that while exercise therapy and the promotion of PA are potentially beneficial, further research is required to establish a robust evidence base.

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