The Physical Therapist’s Role in the Management of the Multisystem Effects Associated With Chronic Kidney Disease: A Case Simulation Based on Clinical Practice Guidelines

Background and Purpose: Chronic kidney disease (CKD) affects approximately 37 million Americans and is a leading cause of mortality. Chronic kidney disease is a systemic, progressive disease that impacts multiple bodily systems, including bone, skeletal muscle, heart, and vasculature, leading to conditions such as osteoporosis, sarcopenia, frailty, and heart failure. Despite these impairments, physical therapists (PTs) are not commonly integrated into the interdisciplinary care team. This simulated case study aims to provide PTs with plan of care recommendations for patients with CKD and to facilitate interdisciplinary collaborations between primary care physicians, nephrologists, and PTs. Methods: Multiple clinical practice guidelines (CPGs) related to pathophysiological changes in CKD were identified and synthesized to direct PT-guided care and inform nephrologists of key indicators warranting physical therapy referral. Recommendations include exercise prescription, screening, assessment, and promotion of interdisciplinary care. The study emphasizes the importance of early intervention and episodic care to manage musculoskeletal health and improve quality of life for patients with CKD. Results and Discussion: The case simulation presents a 58-year-old woman with stage 4 CKD who was referred to PT. The tests, measures, and interventions utilized were guided by the synthesized recommendations from multiple CPGs. The case highlights the need for principles of geriatric physical therapy regardless of age, proactive episodic care, and a tailored exercise program to mitigate musculoskeletal deterioration. The case underscores the necessity of integrating PTs into the CKD care team to address the multisystem effects of the disease and improve patient outcomes. Conclusion: There is a greater need for better communication and involvement across the medical specialties that manage those with CKD. Patients with CKD experience a multitude of changes in their bodily systems that impact their mobility and quality of life. This simulated case study provided direction on the management of musculoskeletal health where one does not currently exist by synthesizing recommendations across multiple CPGs. Although these guidelines were not originally developed with this population in mind, they provide direction for clinicians to treat these patients.