Executive summary of the clinical practice guideline for renal rehabilitation 2026: systematic reviews and recommendations of exercise therapies, nutritional therapies, and multidisciplinary care in patients with chronic kidney diseases

Abstract 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.