Reduction of Mortality Prior to and During the First 90 Days of Dialysis Through a Renal Rehabilitation Program

The mortality rate of treated patients with end stage renal disease(ESRD)is 22 deaths
patient-years at risk in 2006. Incident patients with ESRD are most vulnerable within the
first 90 days of dialysis, with an annualized mortality rate of 50 deaths/100 patient years.
The vast majority of these deaths are due to cardiovascular causes. As cardiac
rehabilitation programs have shown a 20% reduction in one year overall mortality rate post
myocardial infarction the investigator proposes that a similar type of rehabilitation
program will also have a benificial effect on morbidity and mortality in patients with
chronic kidney disease(CKD)and ESRD.The overall goal of this project is to study whether a
renal rehabilitation program based on guided exercise implemented in patients with stage III
and stage IV CKD can influence the mortality rate of these patients prior to and during the
first 90 days of dialysis

Hypothesis:The application of a guided exercise program (renal rehabilitation) instituted in
patients with stage III or Stage IV CKD will decrease the mortality rate prior to the
initiation of renal replacement therapy.

Hypothesis:The application of renal rehabilitation during the late stages of CKD will
decrease the mortality risk during the first 90 days of renal rehabilitation therapy.

Hypothesis:A guided exercise program will have an immediate and prolonged effect on activity
levels, mental health and adaption to chronic illness in patients with advanced CKD.