Is Exercise a Cost-Effective Intervention for People Receiving Hemodialysis? A Narrative Review

Chronic kidney disease is associated with elevated cardiovascular morbidity andmortality, which is particularly high in individuals with end-stage kidney disease re-ceiving hemodialysis and leads to a disproportionate use of health care services.Although exercise is recommended for these patients, specific programs of exer-cise are yet to be implemented as part of routine care, which may be partly dueto uncertainty over the cost-effectiveness of such programs. Within the current cli-mate of limited funding and resources, health care providers are increasingly underpressure to ensure new treatments are cost-effective. Exercise programs havedemonstrated some benefit to physical function and quality of life when used aspart of the management of end-stage kidney disease. This may lead to reductionsin the growing patient costs and hospitalizations, and improve quality of life. How-ever, the cost-effectiveness of programs of exercise in this population has notbeen previously reported. Therefore, the objectives of this review are to describecost-effectiveness, to highlight the potential for exerciseprograms to be cost-effectivein this population, and to identify some future directions