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Chronic kidney disease — ESENeph MCQ

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HardExercise PrescriptionChronic kidney diseaseESENeph

A stable adult with CKD G3b is inactive and asks whether exercise will accelerate kidney failure. Blood pressure is controlled and there are no unstable symptoms. What is the best advice?

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Correct answer: BBuild toward 150 minutes of moderate activity weekly

The best answer is “Build toward 150 minutes of moderate activity weekly”. KDIGO encourages moderate-intensity activity for at least 150 minutes weekly or a level compatible with tolerance. Anaemia, cardiovascular disease, frailty, bone health, access protection and transplant anatomy may require adaptation rather than inactivity. “Avoid aerobic activity because eGFR is below 45 mL/min/1.73m²” is less appropriate because stable CKD is not a contraindication to graded physical activity “Begin maximal lifting without assessing cardiovascular or bone risk” is less appropriate because activity should be individualised to tolerance, comorbidity and conditioning “Use deliberate dehydration during exercise to limit oedema” is less appropriate because dehydration can precipitate acute kidney injury and hypotension “Restrict movement to bed-based exercise because CKD is progressive” is less appropriate because this promotes deconditioning without a kidney-protective rationale

Reference: KDIGO 2024 CKD guideline: https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf