Introduction: Chronic kidney disease (CKD) is a global health challenge, with rising numbers of patients requiring hemodialysis. Optimizing dialysis adequacy, fluid control, and cognitive function is essential for improving quality of life. This systematic review evaluates the impact of renal rehabilitation programs on these outcomes.
Methods: We systematically searched PubMed, Scopus, Web of Science, and SID for studies (2015–2025) assessing nutritional counseling, physical exercise, or cognitive training in hemodialysis patients. Irrelevant papers and non-systematic reviews were excluded. Twenty-three eligible articles were analyzed.
Results: Out of 1,246 records initially retrieved, 23 studies met the inclusion criteria. Renal rehabilitation interventions consistently improved dialysis adequacy (Kt/V, urea reduction ratio), enhanced fluid control (reduced interdialytic weight ga in, improved blood pressure stability), and ameliorated cognitive function (measured by validated neuropsychological scales). Nutritional counseling was particularly effective in reducing fluid overload, while structured exercise programs demonstrated the most robust impact on overall physical performance and dialysis efficiency. Cognitive training showed promising but less consistent results due to limited sample sizes and methodological heterogeneity.
Conclusion: Multifaceted renal rehabilitation programs significantly improve clinical outcomes in hemodialysis patients, with physical activity providing the strongest evidence of benefit. In resource-constrained settings, prioritizing exercise-based interventions may yield the greatest clinical impact. Further large -scale, multicenter trials are required to optimize intervention protocols and confirm long-term benefits.