The association of physical activity with renal outcome and mortality in advanced chronic kidney disease (CKD; i.e., estimated glomerular filtration rate [eGFR] < 45 ml/min/1.73m²) is poorly studied. We examined this association in patients with advanced CKD in Japan. We used the Rapid Assessment of Physical Activity to assess baseline physical activity and classify patients as active or inactive. CKD progression was defined as 40% decline in eGFR, eGFR < 10, or requiring dialysis or transplantation. Among the 1,808 eligible patients, after adjusting for possible confounders, hazard ratios (HRs) for poor renal outcome in the active group were 0.68 (95% CI, 0.44–1.04), 1.09 (0.86–1.38), and 1.01 (0.82–1.25) in CKD stage G3b, G4, and G5, respectively, suggesting a renal benefit of exercise in CKD stage G3b. Adjusted HRs for death were 0.79 (0.40–1.57), 0.55 (0.38–0.80), and 0.75 (0.44–1.26) in stage G3b, G4, and G5, respectively. While the adjusted HRs of death were 0.84 (0.52–1.38) and 0.60 (0.43–0.83) in diabetic and non-diabetic patients, suggesting that exercise may reduce mortality in non-diabetic patients. Our study suggests that exercise is associated with better survival in non-diabetic patients with CKD stage G3b-5, and better renal outcome in diabetic and non-diabetic CKD stage G3b.

We aimed to develop a novel method for measuring the complement-binding ability of anti-blood type antibodies (ab-Abs), the flow cytometry method for the complement C1q test (FCM-C1q) for detecting antibody-mediated rejection (AMR) caused by ab-Abs in ABO-incompatible kidney transplantation (ABOI-KTx). FCM-C1q distribution was surveyed in 44 healthy participants and 43 dialysis patients (Cohort A). The relationship between AMR and FCM-C1q levels was examined along with ab-Ab titers by the flow cytometry method for the IgG test (FCM-IgG) in 62 ABOI-KTx patients (Cohort B). FCM-IgG and C1q levels were significantly higher in type O participants than in A/B participants in Cohort A. There were minimal differences in the distribution of FCM-IgG and C1q between dialysis and healthy participants. Sixteen cases were suspected of acute rejections (ARs) in Cohort B, of whom nine had AR clinically. One patient with severe AMR was highly suspected of hyperacute rejection along with another patient with severe AMR. Their postoperative FCM-C1q and FCM-IgG levels were elevated. Another two patients showed high FCM-IgG and C1q levels before KTx, and these levels remained low after KTx with no or mild rejection. In conclusion, our results suggest that a high positivity rate for FCM-C1q may predict moderate to severe AMR caused by ab-Abs and poor prognosis in ABOI-KTx.

The concept of renal rehabilitation has become increasingly recognized among physicians, nurses, pharmacists, dietitians, physical therapists, occupational therapists, other healthcare professionals, and patients. In 2018, the Japanese Society of Renal Rehabilitation published the first clinical practice guideline for renal rehabilitation. Since then, evidence on exercise therapy, nutritional therapy, multidisciplinary care, and lifestyle modifications in patients with chronic kidney disease (CKD) has increased. The 2026 revision covers the full CKD spectrum, including non-dialysis-dependent CKD, hemodialysis, peritoneal dialysis, and kidney transplantation. Systematic reviews were conducted with predefined outcomes, including all-cause mortality, cardiovascular events, physical function and physical activity, health-related quality of life, nutritional and inflammatory markers, dialysis adequacy, and adverse events. A major feature of this revision was the addition of new domains. New systematic reviews were conducted on physical therapist-led interventions, multidisciplinary care involving nurses, and combined exercise and nutritional interventions. A total of 12 recommendations were developed across the main domains of renal rehabilitation: non-dialysis-dependent CKD, dialysis therapy, kidney transplantation, physical therapy, multidisciplinary care and nursing, and nutritional therapy. Recommendation grades were determined by consensus among patient representatives and professionals from various disciplines. Although the certainty of evidence for hard outcomes remains limited, consistent benefits were observed for physical function, quality of life, and other patient-centered outcomes. This revised guideline positions renal rehabilitation as a core component of CKD care and emphasizes multidisciplinary collaboration and sustained, patient-centered implementation throughout the disease course.