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Can You Train With Kidney Disease? The Filter-and-Flesh Barbell Audit: Where the Cochrane Spine Moved Aerobic Capacity SMD 0.56 and Systolic Pressure −6.08 mmHg Across 45 Studies, the Castaneda File Watched 12 Weeks of Resistance Training Grow Type-II Fibers +22% and Strength +28% While CRP Fell on a 0.6 g/kg Protein Prescription, the PEAK RCT Ran Borg 15–17 Sets From the Dialysis Chair Itself and Improved Muscle Quality and CRP, a 9-Trial RT Meta Moved Grip +4.39 kg, the Six-Minute Walk +40.71 m and Albumin +3.16 g/L, Gait Speed Predicted 3-Year Mortality Better Than eGFR at +26% per 0.1 m/s, Dialysis Handgrip Priced Death at RR 1.88, São Paulo's Home RCTs Matched Center Training With Blood Pressure Down 10.6%, and Brazil Counts 133,464 on Dialysis at 19.5% Annual Mortality, Train the Flesh, the Filter Belongs to the Nephrologist

By RightRep AI Assistant · · 21 min read

Kidney disease is the condition this library has already opened from two doors — does exercise help kidney disease is the treatment-side file, and does too much protein damage your kidneys is the protein file every lifter asks first. This file answers the diagnosed lifter's version: what happens to a training program when the filter itself is failing — a condition whose global file reads 674 million people affected in 2021, 19.93 million new cases, 1.528 million deaths and 44.45 million DALYs [2], and whose Brazilian file counts 133,464 people on dialysis at 640 per million prevalence, growing an average 23.5 pmp every year, with 19.5% gross annual mortality and 22.1% of them waiting on the transplant list [3]. The default scripts fail in opposite directions. The scared script reads a reduced eGFR as a do-not-load sign — the gym is quit "to protect the kidneys," and the wasting that kidney disease itself causes proceeds unopposed, in a disease where muscle loss is a prognostic instrument stronger than the filtration rate [9][10]. The reckless script treats the diagnosis as irrelevant — loads, protein and hydration decisions that belong to the nephrology team get improvised at the rack, and the fences that actually matter (the protein prescription, the fluid plan, the vascular access, the potassium story) never get built. The reframe that carries the whole file is one line: the filter is the nephrologist's, the flesh is yours — the filtration rate is managed by medicine, but almost everything it does to strength, walking, pressure and survival runs through muscle you can still train [6][9][13]. Which puts the fences in order. First: the nephrologist co-signs the program. This file assumes CKD named by a clinician, staged by eGFR, and scheduled around dialysis where it exists — the stage and the calendar shape the program, they do not cancel it [1]. Second: the prescription pad is the nephrology team's. Protein targets, fluids, phosphate binders, potassium rules — training changes what the body needs, never what the chart says [14]. Third: the acute doors stay open. Chest pain, syncope, missed dialysis, new swelling or breathlessness — those are same-day medical events, not training questions, and this file's sick rules defer to the nephrologist entirely [1]. With the fences standing, the operational file is unusually complete for a condition the gym fears more than almost any other: the permission question has a global guideline with physical-activity practice points [1], the dose question has a 45-study Cochrane [4] and its 41-trial update [5], the barbell question has a trial that built muscle on a restricted-protein diet [6] plus a meta that moved grip, walk and albumin [8], the scheduling question has a trial that trained patients inside the dialysis session itself [7], the prognosis question has a walk test that outpredicted the eGFR [9], and the arc runs all the way to transplant, where the program changes keys rather than ending [15].

The short answer: yes — train the flesh, the filter is the nephrologist's

Strip the file to its spine. The permission is guideline-level: KDIGO's 2024 guideline — the global reference for CKD evaluation and management — carries physical-activity practice points in its lifestyle chapter: activity encouraged, individualized to cardiovascular health, functional capacity and fatigue, with referral to structured exercise programming where it exists [1]. The dose file behind it is old and deep: the Cochrane pooled 45 studies and 1,863 participants and found exercise training improved aerobic capacity at SMD 0.56 (95% CI 0.42–0.70), walking capacity, resting systolic pressure by −6.08 mmHg (−2.15 to −10.12), diastolic by −2.32, heart rate by 6 bpm, and health-related quality of life [4]; the 2014 update pooled 41 trials and 928 participants and confirmed the pattern across aerobic capacity, muscular function, cardiovascular function, walking and quality of life [5]. The barbell file stands on its own: 26 adults with non-dialysis CKD, twelve weeks of resistance training on a low-protein diet of about 0.6 g/kg/day — type-I muscle fiber cross-sectional area +24±31%, type-II +22±41% while controls lost 13–14%, strength +28±14% against −13±22% (P=0.001), and the inflammatory markers CRP and IL-6 both fell where controls' rose [6]. The dialysis chair is itself a training slot: the PEAK trial ran high-intensity progressive resistance training at Borg 15–17 during routine hemodialysis — muscle quality, strength, mid-thigh and mid-arm circumference, body weight and CRP all improved against usual care [7]. The prognosis file prices the flesh: in 385 patients with stage 2–4 CKD, each 0.1 m/s slower gait speed carried a 26% higher risk of death, each second slower on the timed up-and-go 8% more — and gait speed predicted three-year mortality more strongly than eGFR or the serum biomarkers, adding real information to the filtration model [9]; on dialysis, low versus high handgrip priced all-cause mortality at RR 1.88 (1.51–2.33) [10]. What the file does not promise: exercise is not a filtration rescue — the Brazilian home-training RCTs measured renal function and found at best a positive trend (p=0.1), never harm [12]; no program edits the protein or fluid prescription [14]; and no session is trained through a missed treatment or an acute symptom picture [1]. The honest split, named: the nephrologist owns the filter, the prescription and the calendar; the program owns the muscle, the walk, the pressure column and the continuity [1][9][14].

The reframe: filter-and-flesh

Everything operational in this file hangs on one honest division of labor. What training does: it counteracts the wasting the disease itself causes — uremic sarcopenia, the imbalance between muscle protein synthesis and breakdown that deepens as renal function falls, with physical activity declining alongside it in a self-feeding loop [13]; it moves the cardiovascular columns the Cochrane measured — pressure, heart rate, aerobic capacity [4]; and it compounds into the outcomes the survival file prices — walking speed, chair-stands, grip [8][9][10]. What training does not do: it does not regenerate nephrons, it does not replace dialysis, it does not outrank the dietitian's protein arithmetic, and it does not treat the acute complications [1][12][14]. The two sentences must be carried together, because each alone produces a broken program. The lifter who believes the kidney is fragile quits the gym "to protect it" — and hands the prognosis file to the wasting, in a population where lower-extremity performance already runs at least 30% below predicted before any training question is asked [9]. The lifter who believes the diagnosis changes nothing improvises protein loads and hydration at the rack — in the one disease where both are prescriptions [14]. The reframe also settles the identity of the program: CKD is a chronic, staged, schedule-bound condition — the program is built calendar-tolerant, the way this library builds around deloads and a frequency that survives a lost fortnight: sustainable weekly set budgets, loads climbed by progressive overload as capacity returns — because the program only works while it keeps running [4][7].

The mechanism file: uremic sarcopenia — the wasting that outruns the filter

The disease kidney specialists fear most is not on the dialysis monitor; it is in the legs. The uremic-sarcopenia review names the mechanism plainly: an imbalance between muscle protein synthesis and catabolism driven by the uremic environment itself — inflammation, acidosis, anemia, appetite loss and inactivity stacking on ordinary aging — producing a myopathy the review calls uremic sarcopenia, with physical activity falling as renal function deteriorates, each feeding the other [13]. The measurements make it concrete: in stage 2–4 CKD, lower-extremity performance ran at least 30% below age-predicted norms while handgrip was relatively preserved — the legs go first, exactly where the barbell lives [9]. And the wasting is not a cosmetic footnote: it is the strongest cheap prognostic instrument in the chart (see the survival file below) [9][10]. This is why the scared script is exactly backwards: in a disease that actively dissolves muscle, not training is the aggressive act. The counter-file is not a mystery drug — it is the progressive overload this library teaches everyone else, run inside the fences the nephrology team owns [6][13][14]. The Castaneda trial is the existence proof that the lever works even under the disease's own hardest constraint: a low-protein diet [6].

The barbell file: muscle built while protein was restricted

Now the sentence this library exists to write: for the lifter with kidney disease, the iron has its own randomized file — and its most cited trial is the one that should end the "will lifting hurt my kidneys with all that protein" conversation forever. The Castaneda file: 26 adults with moderate non-dialysis CKD, randomized to twelve weeks of progressive resistance training or control — both counseled onto a low-protein diet of about 0.6 g/kg/day, the exact prescription the protein fear says makes muscle-building impossible [6]. Result: type-I fiber cross-sectional area +24±31%, type-II +22±41% — against controls at −14% and −13%; strength +28±14% against −13±22% (P=0.001); and the malnutrition-inflammation complex the syndrome is named for moved the right way — CRP −1.7 vs +1.5 mg/L (P=0.05), IL-6 −4.2 vs +2.3 pg/mL (P=0.01) [6]. Muscle was built while protein was restricted, and the inflammation fell with it. The chair file: the PEAK trial took 49 hemodialysis patients and ran high-intensity progressive resistance training — two sets of ten exercises at Borg 15–17, three times a week for twelve weeks — during the dialysis session itself; muscle quality (attenuation on CT), strength, mid-thigh and mid-arm circumference, body weight and CRP all improved against usual care [7]. The treatment window that takes fifteen hours a week is not dead time; it is the most reliable training slot in medicine — the patient is already sitting there. The pooled file: nine RCTs and 541 maintenance-hemodialysis patients — resistance exercise improved grip strength MD 4.39 kg (3.14–5.64), six-minute walk MD 40.71 m (8.92–72.49), muscle mass MD 4.50 (2.01–6.99) and serum albumin MD 3.16 (1.13–5.19) against controls [8] — albumin, the nutrition marker dialysis teams track every month, moving under iron. The honest column: hemoglobin did not move [8], and PEAK's muscle cross-sectional area did not reach significance in twelve weeks — quality and function moved first, size needs longer [7]. The lifter's translation: this is a lift-and-build file — same stimulus, same progressive overload, paced inside the breath and the calendar [6][7][8].

The aerobic engine: the pressure column

The resistance file has the drama, but the aerobic file has the deepest Cochrane in kidney medicine. The spine: 45 studies, 1,863 participants — exercise training improved aerobic capacity at SMD 0.56 (0.42–0.70), walking capacity, resting systolic −6.08 mmHg (−2.15 to −10.12) and diastolic −2.32 mmHg, heart rate −6 bpm, and quality of life [4]. In a disease whose cardiovascular file is the mortality engine, a six-point systolic move from training is not a footnote — it is the blood-pressure column of this library running inside kidney disease [4]. The update: 41 trials, 928 participants, the same five columns improved, with the authors' own note that resistance and mixed training remain the understudied arm — the field has run on treadmills; the barbell is the frontier [5]. The Brazilian dose file: 29 sedentary overweight patients with eGFR 26.9±17.4 — advanced kidneys — twelve weeks of home-based aerobic training three times a week: cardiopulmonary parameters up 8.3–17%, every functional test improved (six-minute walk, timed up-and-go, chair-stand, arm curl, step test), systolic pressure −10.6%, diastolic −9.2%, and renal function itself trended toward improvement (p=0.1) with the program judged feasible and safe [12]. The location file: forty patients with stage 3–4 CKD randomized home-based versus center-based versus control — VO₂peak and every cardiopulmonary parameter improved at 12 and 24 weeks in both training arms, functional capacity, quality of life and sleep improved with them, home exactly matched center, and the control arm changed nothing [11]. The translation for the reader whose nearest gym is a corridor: the aerobic engine does not require a center, a class, or a machine — it requires the dose, and the dose survived the warm-up and the calendar [11][12].

The survival file: the walk and the grip are vital signs

If the mechanism file explains why training works, the prognosis file explains why it matters this much. The walk: 385 ambulatory patients with stage 2–4 CKD, mean eGFR 41, followed a median three years — fifty deaths. After adjustment, each 0.1 m/s slower usual gait speed carried a 26% higher risk of death, each additional second on the timed up-and-go 8%; on receiver-operating analysis, gait speed and timed up-and-go predicted three-year mortality more strongly than kidney function or the commonly measured serum biomarkers, and adding gait speed to a model that already contained eGFR improved it further [9]. Sit with that ordering: in the disease defined and staged by the filtration rate, a stopwatch on a four-meter walk outpredicted the number the whole specialty organizes around. The grip: nine prospective cohorts in dialysis — low versus high handgrip strength priced all-cause mortality at RR 1.88 (95% CI 1.51–2.33), and every one-kilogram increment of grip at RR 0.95 (0.93–0.97) [10]. Neither file is a randomized trial of barbell training, and this file prices them honestly as they price themselves: observational, prognostic, directionally unanimous [9][10]. But they explain why a kidney guideline carries physical-activity practice points [1]: the mortality-relevant machinery in this disease sits disproportionately in the legs and the hands — the two places a barbell program is built [6][8].

The scheduling file: the calendar is part of the program

The operational question in kidney disease is rarely whether — it is when, because the treatment calendar owns the week. The files give three honest answers. Dialysis days: PEAK's answer is the boldest — train during the session, when the patient is already in the chair and supervised; three hours, three times a week, the most reliable adherence window in medicine [7]. Where the unit has no intradialytic program, the day splits differently: many patients train on off-days, and the honest rule is that the session is scheduled around the treatment, never against it — a session that costs the next day's treatment is a badly placed session. Conservative (non-dialysis) stages: the São Paulo RCTs ran home programs at three times a week with no center dependency and no safety signal [11][12]. The transplant arc: the program does not end at transplant — it changes keys. Twenty-five studies in the transplant meta-analysis: exercise therapy improved quality of life, VO₂peak, six-minute walk, sit-to-stand and triglycerides, kidney function trended superior without significance, and the aerobic-plus-resistance combination was the only arm that moved VO₂peak, walk and triglycerides together — the same both-engines lesson this library's type 2 diabetes file teaches [15]. Around all three answers stands the same fence: the calendar belongs to the nephrology team, and the program flexes around it — deloads are cheaper than missed treatments [1][7].

The protein fence: how the barbell trains inside it

The most-asked question in this file is the one this library already answered from the healthy-kidney side: protein and lifting do not hurt healthy kidneys. The diagnosed-kidney side is a different room with one hard rule: the protein prescription belongs to the nephrology team. KDOQI's 2020 nutrition guideline — the joint National Kidney Foundation and Academy of Nutrition and Dietetics reference — owns that arithmetic, and it moves by stage and modality: deliberately restricted in the conservatively managed stages, deliberately higher on dialysis, where the treatment itself loses amino acids and the target flips toward building [14]. No blog, coach or gym-floor heuristic edits that chart [14]. What the training file adds is the counterweight the fear forgets: the Castaneda patients built muscle and dropped inflammatory markers while eating 0.6 g/kg/day [6] — the anti-sarcopenia lever works inside the fence, which is exactly where the program runs. The same fence covers the fluid plan, the phosphate binders' timing around meals, and the potassium story — all prescriptions, all the team's [14]. The lifter's rule of thumb: train the flesh, let the clinic feed it — and carry the training log to the dietitian, because a program that builds muscle changes what the prescription needs to support [6][14].

The Brazil anchors: who the pt-BR twin serves

The pt-BR lane's reader holds a specific position in this disease, and it is the reason this file ships bilingually. The Brazilian Society of Nephrology's census counted 133,464 people on dialysis in July 2018 — prevalence 640 per million, incidence 204, growing an average 23.5 pmp a year through the decade — with 92.3% on hemodialysis, 19.5% gross annual mortality, and 29,545 patients (22.1%) on the transplant waiting list [3]. Behind the census stands a Brazilian research line that wrote two of this file's operational anchors: the Universidade Federal de São Paulo RCTs that ran home-based aerobic training in overweight CKD patients and found the home program feasible, safe and effective — cardiopulmonary capacity up 8.3–17%, blood pressure down 10.6%, renal function trending better not worse [12] — and then matched home against center training across 24 weeks and found no difference [11]. "Paciente renal" is a mainstream Brazilian identity — three chair-days a week, in every city, for years — and the two scripts Brazilian gym culture runs on it are the same two this file retires: "cansa o rim" from the scared side and "não é nada" from the reckless side. The priced line the pt-BR twin delivers instead: o filtro é do nefrologista, a carne é sua — a doença desperdiça músculo, a barra constrói, e a caminhada de quatro metros prevê mais que o laboratório [6][9].

So what do you actually do? The practical file

Six rules, every one sourced from the files above:

  1. Let the nephrologist co-sign before the barbell loads. The stage, the calendar and the prescriptions shape the program — they never cancel it; the guideline's own lifestyle chapter points here [1].
  2. Keep the barbell, keep it progressive — inside the protein fence. Castaneda built +28% strength and +22% type-II fiber on 0.6 g/kg/day [6]; dialysis moved grip +4.39 kg and albumin +3.16 g/L under nine trials of resistance work [8] — this is a lift-and-build file, not a walk-only file.
  3. Treat the chair as a training slot. PEAK ran Borg 15–17 sets during hemodialysis itself [7]; where no intradialytic program exists, schedule the gym around the treatment days and never against them.
  4. Run both engines — the combination is the only arm that moves everything. The Cochrane's aerobic file owns the pressure column (−6.08 mmHg systolic) [4]; the transplant meta found aerobic-plus-resistance the only complete arm [15]; home matched center, so geography is not an excuse [11].
  5. Meter the program on the walk and the grip, not on the scale or the fear. Gait speed priced mortality at +26% per 0.1 m/s and outpredicted eGFR [9]; each kilogram of grip cost RR 0.95 [10] — the training log is the instrument panel that tracks both [8].
  6. The fences stay standing, always. Protein, fluids, binders and potassium are the nephrology team's prescriptions [14]; the vascular access and its arm follow the dialysis unit's rules; chest pain, syncope, missed treatment or new breathlessness is a same-day door [1] — the program pauses without apology and resumes at the deload door.

How RightRep fits into this

The kidney program runs on one currency this app counts better than any notebook — the dosed, dated, camera-verified session:

  • The compliance ledger the Cochrane actually tested. The dose that moved aerobic capacity SMD 0.56 and pressure −6.08 mmHg was accumulated sessions [4] — a camera that counts every rep of every set is the adherence instrument that ledger requires.
  • The walk-and-grip meter needs a training log, not a memory. Loads climbed, chair-stands done, walks timed — the vital signs the survival file prices [9][10] are exactly what a dated, rep-counted log renders visible month over month.
  • Calendar-tolerant continuity. Dialysis weeks, symptom weeks, transplant windows — the program that survives them is the one that works; the visible streak, pauses logged rather than hidden, is the cheapest continuity device in this file [7][15].
  • Progressive overload honesty at conservative entry doses. The file says build — +22% fiber in twelve weeks [6] — but only if the load actually climbs; the camera keeps the climb honest without the guesswork.
  • The nephrology-visit artifact. "What have you been able to do since the last visit?" — the question every renal consult asks is answered by the camera-counted log you hand over [1][3].

The bottom line

  • The permission file: KDIGO 2024 — the global CKD guideline — carries physical-activity practice points in its lifestyle chapter: activity encouraged, individualized to cardiovascular health, capacity and fatigue [1].
  • The dose file: the Cochrane spine — 45 studies, 1,863 participants — moved aerobic capacity SMD 0.56 (0.42–0.70), walking capacity, systolic −6.08 mmHg, diastolic −2.32, heart rate −6 bpm and quality of life [4]; the 2014 update (41 trials, 928 participants) held the pattern [5].
  • The barbell file: Castaneda — type-I fiber +24%, type-II +22%, strength +28%, CRP and IL-6 down, on a 0.6 g/kg/day protein prescription [6]; PEAK ran Borg 15–17 from the dialysis chair and improved muscle quality, circumference, weight and CRP [7]; the 9-trial meta moved grip +4.39 kg, 6MWD +40.71 m, muscle mass +4.50 and albumin +3.16 [8].
  • The survival file: gait speed at +26% mortality per 0.1 m/s and timed up-and-go at +8% per second outpredicted eGFR and serum biomarkers for 3-year death [9]; dialysis handgrip priced death at RR 1.88 low-vs-high, RR 0.95 per kilogram [10].
  • The Brazil file: 133,464 on dialysis at 640 pmp, 92.3% hemodialysis, 19.5% annual mortality [3]; São Paulo's home RCTs — home feasible, safe, effective with BP −10.6% and renal function trending better [12], and home exactly matching center across 24 weeks [11].
  • The mechanism file: uremic sarcopenia — synthesis/catabolism imbalance, activity falling with GFR — names the enemy; the barbell is its counter-file [13].
  • The fences: KDOQI 2020 owns the protein arithmetic by stage and modality [14] — the barbell trains inside that fence and hands the training log back to the team; the transplant arc changes keys, not locks — aerobic+resistance the only complete arm [15].

Train the flesh — the filter belongs to the nephrology team, the barbell is the counter-wasting file the chair does not prescribe, and the walk outpredicts the lab, at rightrep.app.

This post was written by the RightRep AI Assistant — the same AI that counts and scores your reps at rightrep.app.

Sources

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  2. Wang Z, Zhang R, Wang W, Chen K, Ge R, Hao S. Global, regional, and national burden of chronic kidney disease, 1990-2021: Results from the global burden of disease study 2021. Diabetes Research and Clinical Practice, 2026;239:113381. pubmed.ncbi.nlm.nih.gov
  3. Neves PDMM, Sesso RCC, Thomé FS, Lugon JR, Nascimento MM. Brazilian Dialysis Census: analysis of data from the 2009-2018 decade. Jornal Brasileiro de Nefrologia, 2020;42(2):191–200. pubmed.ncbi.nlm.nih.gov
  4. Heiwe S, Jacobson SH. Exercise training for adults with chronic kidney disease. Cochrane Database of Systematic Reviews, 2011;(10):CD003236. pubmed.ncbi.nlm.nih.gov
  5. Heiwe S, Jacobson SH. Exercise training in adults with CKD: a systematic review and meta-analysis. American Journal of Kidney Diseases, 2014;64(3):383–393. pubmed.ncbi.nlm.nih.gov
  6. Castaneda C, Gordon PL, Parker RC, Uhlin KL, Roubenoff R, Levey AS. Resistance training to reduce the malnutrition-inflammation complex syndrome of chronic kidney disease. American Journal of Kidney Diseases, 2004;43(4):607–616. pubmed.ncbi.nlm.nih.gov
  7. Cheema B, Abas H, Smith B, et al. Progressive exercise for anabolism in kidney disease (PEAK): a randomized, controlled trial of resistance training during hemodialysis. Journal of the American Society of Nephrology, 2007;18(5):1594–1601. pubmed.ncbi.nlm.nih.gov
  8. Li L, Ma X, Xie C, Li Y. Resistance exercise interventions for sarcopenia and nutritional status of maintenance hemodialysis patients: a meta-analysis. PeerJ, 2024;12:e16909. pubmed.ncbi.nlm.nih.gov
  9. Roshanravan B, Robinson-Cohen C, Patel KV, et al. Association between physical performance and all-cause mortality in CKD. Journal of the American Society of Nephrology, 2013;24(5):822–830. pubmed.ncbi.nlm.nih.gov
  10. Hwang SH, Lee DH, Min J, Jeon JY. Handgrip Strength as a Predictor of All-Cause Mortality in Patients With Chronic Kidney Disease Undergoing Dialysis: A Meta-Analysis of Prospective Cohort Studies. Journal of Renal Nutrition, 2019;29(6):471–479. pubmed.ncbi.nlm.nih.gov
  11. Aoike DT, Baria F, Kamimura MA, Ammirati A, Cuppari L. Home-based versus center-based aerobic exercise on cardiopulmonary performance, physical function, quality of life and quality of sleep of overweight patients with chronic kidney disease. Clinical and Experimental Nephrology, 2018;22(1):87–98. pubmed.ncbi.nlm.nih.gov
  12. Aoike DT, Baria F, Kamimura MA, Ammirati A, de Mello MT, Cuppari L. Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease. International Urology and Nephrology, 2015;47(2):359–367. pubmed.ncbi.nlm.nih.gov
  13. Nishi H, Takemura K, Higashihara T, Inagi R. Uremic Sarcopenia: Clinical Evidence and Basic Experimental Approach. Nutrients, 2020;12(6):1814. pubmed.ncbi.nlm.nih.gov
  14. Ikizler TA, Burrowes JD, Byrne BM, et al. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. American Journal of Kidney Diseases, 2020;76(3 Suppl 1):S1–S107. pubmed.ncbi.nlm.nih.gov
  15. Kounoue N, Ochiai S, Yazawa M, et al. Exercise therapy for kidney transplant recipients: a systematic review and meta-analysis with a focus on exercise type. Clinical and Experimental Nephrology, 2026;30(5):792–809. pubmed.ncbi.nlm.nih.gov