Combined intradialytic exercise and nutritional supplementation in sarcopenic geriatric haemodialysis patients: A narrative review

Background. Geriatric patients with end-stage renal disease (ESRD) are disproportionately affected by the sarcopenia-CKD axis — a pathophysiological continuum in which uraemic toxicity, chronic inflammation, metabolic acidosis, and haemodialysis-induced catabolism synergistically accelerate skeletal muscle loss and precipitate the frailty phenotype. In Poland, CKD affects 17.3% of individuals aged 60+ and 59.7% of those aged 90+ (PolSenior2), underscoring the epidemiological urgency of effective rehabilitative strategies. Aim. To synthesise evidence on the efficacy of combined intradialytic exercise (IDE) and oral nutritional supplementation (IDON) in attenuating sarcopenia and frailty in geriatric ESRD patients undergoing maintenance haemodialysis. Methodology. A narrative review encompassing RCTs, systematic reviews, meta-analyses, and clinical guidelines published 2006–2025, identified via PubMed/MEDLINE, Scopus, and Web of Science. Key outcomes: Six-Minute Walk Test (6MWT), handgrip strength, and Short Physical Performance Battery (SPPB). Results. Twelve-week structured IDE programmes yielded clinically meaningful improvements in ambulatory capacity (6MWT: +34.3 m, exceeding MCID of 25 m; p < 0.001; η² = 0.38), handgrip strength (+2.8 kg; p = 0.012; η² = 0.21), and physical performance (SPPB: +1.5 points; p = 0.005; η² = 0.27). Concurrent IDON reversed dialysis-induced net catabolic protein balance (from −0.23 to +0.23 mg/kg/min; p < 0.001). Conclusions. Combined IDE and IDON constitutes a mechanistically grounded rehabilitative strategy consistent with KDIGO 2024 recommendations. The supervised haemodialysis setting offers a structurally optimal framework for delivery in multimorbid elderly patients with limited community exercise access.