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

Chronic kidney disease is associated with elevated cardiovascular morbidity and mortality, which is particularly high in individuals with end-stage kidney disease receiving hemodialysis and leads to a disproportionate use of health care services. Although exercise is recommended for these patients, specific programs of exercise are yet to be implemented as part of routine care, which may be partly due to uncertainty over the cost-effectiveness of such programs. Within the current climate of limited funding and resources, health care providers are increasingly under pressure to ensure new treatments are cost-effective. Exercise programs have demonstrated some benefit to physical function and quality of life when used as part of the management of end-stage kidney disease. This may lead to reductions in the growing patient costs and hospitalizations, and improve quality of life. However, the cost-effectiveness of programs of exercise in this population has not been previously reported. Therefore, the objectives of this review are to describe cost-effectiveness, to highlight the potential for exercise programs to be cost-effective in this population, and to identify some future directions.