ホシノ　ジュンイチ   Hoshino Junichi   星野　純一    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	原著
言語種別	英語
査読の有無	査読なし
表題	Intradialytic Renal Rehabilitation and Mortality: Results from the Registry of Active Renal Rehabilitation in Dialysis Patients (REVEAL-D).
掲載誌名	正式名：Clinical journal of the American Society of Nephrology : CJASN 略　 称：Clin J Am Soc Nephrol ISSNコード：1555905X/15559041
掲載区分	国外
巻・号・頁	pp.online
著者・共著者	Hoshino Junichi, Kida Keisuke, Kobayashi Shizuka, Kono Kenichi, Matsuzawa Ryota, Otobe Yuhei, Kosaki Keisei, Yazawa Masahiko, Tsuchida Yohei, Usui Toshiaki, Ouchi Yuta, Nishiwaki Hiroki, Hasegawa Takeshi, Fujii Naohiko, Sofue Tadashi, Yamagata Kunihiro, Shibagaki Yugo, Narita Ichiei
担当区分	筆頭著者,責任著者
発行年月	2026/07/10
概要	BACKGROUND:Frailty and sarcopenia are increasingly common among patients undergoing maintenance hemodialysis. Globally, some countries including Japan have 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 evaluated 708 adult dialysis outpatients (age, 69.8±11.2; men, 59%; and Clinical Frailty Scale≥6, 13%) at 10 institutions across Japan in January 2021 who were retrospectively assessed over a three-year period, 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 receive this intervention. Cox regression models and propensity score (PS) matching were used to compare three-year mortality after adjustment for the Clinical Frailty Scale, comorbidities, laboratory data and other baseline characteristics.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 (84.6% vs 75.6%, P = 0.007), particularly among men and those with severe frailty. In Cox models, renal rehabilitation was consistently associated with lower mortality (crude HR 0.59 [95% CI, 0.40-0.87]; adjusted HR 0.66 [0.44-1.00]). After propensity score matching, the association remained directionally similar (HR 0.65 [0.40-1.05]). Sex-stratified analyses suggested a stronger association among men (adjusted HR 0.49 [0.27-0.89]) than among women (adjusted HR 0.98 [0.54-1.77]), although the formal test for interaction was not statistically significant (P for interaction = 0.13). Patients meeting exercise-habit criteria (≥2 sessions/week, ≥30 min for ≥1 year) also showed better survival relative to the non-exercise-habit group (adjusted HR 0.60 [0.37-0.96], P = 0.03). No adverse events related to rehabilitation were reported.CONCLUSIONS:Intradialytic renal rehabilitation may be associated with better survival in maintenance hemodialysis patients, particularly in men and in those with severe frailty.
DOI	10.2215/CJN.0000001133
PMID	42455635