Dose-Response Effects of Different Exercise Modalities on Blood Pressure Control in Patients with Chronic Kidney Disease: A Systematic Review and Network Meta-Analysis.

BACKGROUND: Uncertainty persists regarding the dose-response association between exercise exposure and blood pressure (BP) control in chronic kidney disease (CKD). This dose-response network meta-analysis examined whether different exercise modalities and model-estimated metabolic-equivalent exposure levels were associated with changes in systolic BP (SBP) and diastolic BP (DBP). METHODS: Exercise dose was estimated as metabolic equivalents of task minutes per week (MET-min/week) from reported session duration, frequency, and intensity. Primary outcomes were changes in SBP and DBP, with exploratory subgroup analyses by dialysis status, baseline BP, and intervention duration. RESULTS: The analysis included 26 randomized controlled trials (1218 participants). Aerobic exercise was associated with lower SBP, with the greatest model-estimated reduction at 880 MET-min/week (MD, -7.73 mm Hg). Resistance and mind-body exercise also showed model-estimated reductions, whereas combined aerobic-resistance training was not statistically significant. Dose-response estimates differed by dialysis status and intervention length, but several subgroup estimates were based on sparse data and wide uncertainty. Evidence certainty ranged from very low to high (CINeMA). CONCLUSIONS: Exercise interventions may be associated with BP reduction in CKD, but the identified MET-min/week ranges should be interpreted as exploratory, model-derived estimates rather than validated therapeutic thresholds. Better reported randomized trials are needed to confirm dose ranges, safety, adherence, and tolerability in dialysis and non-dialysis CKD populations.