Effects of exercise on clinical outcomes in patients undergoing haemodialysis for chronic kidney disease: an umbrella review

Background: Exercise is increasingly recommended for haemodialysis patients with chronic kidney disease, yet the evidence from meta-analyses remains fragmented, and its methodological quality has not been systematically evaluated. Methods: We systematically searched Embase, PubMed/MEDLINE, Cochrane Library, and Web of Science up to January 2026. We evaluated the methodological quality of studies using the 'Measurement Tool to Assess Systematic Reviews 2'. We used GRADE system to rate the evidence level for each outcome as high, moderate, low, or very low. Results: peak, DBP, PCS, MCS, CRP, and depression, but not Kt/V, 6MWT, or SBP. Conclusions: Aerobic exercise may improve cardiorespiratory fitness, dialysis efficiency, inflammation, and depression; resistance may enhance muscle strength and physical function; combined training offers the broadest benefits. Individualized prescriptions are supported, but high-certainty evidence is lacking. Registration: PROSPERO: CRD420251244373.