Renal Rehabilitation and Its Relationship with Anemia, Nutritional Status, and Activities of Daily Living in Patients Undergoing Maintenance Hemodialysis: A Systematic Review.

Renal rehabilitation is increasingly recognized as a complementary strategy to address the clinical and functional complications of maintenance hemodialysis. This review evaluated the effects of renal rehabilitation, including structured exercise, nutritional support, and multidisciplinary interventions, on anemia, nutritional status, and activities of daily living in adults undergoing maintenance hemodialysis. Studies published between 2015 and 2025 were reviewed according to PRISMA criteria, and 42 studies were included in the qualitative synthesis. Overall, renal rehabilitation was associated with modest improvements in hemoglobin levels and erythropoiesis-stimulating agent responsiveness, as well as favorable changes in nutritional and muscle-related parameters. The most consistent benefits were observed in functional outcomes, including exercise capacity, muscle strength, frailty, and activities of daily living. These findings support renal rehabilitation as a promising multidimensional approach in maintenance hemodialysis, although heterogeneity among interventions and study designs highlights the need for standardized, adequately powered long-term trials.