Exercise modality and dose effects on renal function in non–dialysis chronic kidney disease: a Bayesian model-based network meta-analysis

Chronic kidney disease (CKD) is a major global health challenge. Exercise is a key non-pharmacological therapy, but the most effective modality and dose for improving renal function in non-dialysis CKD is unclear. To compare exercise modalities and quantify dose–response effects on estimated glomerular filtration rate (eGFR) in adults with non-dialysis CKD. We searched PubMed, Web of Science, Cochrane Central, EBSCO, Embase, and CNKI from inception to July 2025 for randomized controlled trials (RCTs) involving adults with non-dialysis CKD. Exercise interventions were classified as aerobic training (AT), resistance training (RT), or mixed physical activity (MPA), which included combined training and other multicomponent interventions. Doses were converted to MET-min/week. A Bayesian dose–response network meta-analysis estimated effects and dose thresholds for eGFR. Twenty-five RCTs involving 1,827 adults with non-dialysis CKD were included. Studies were published between 2012 and 2024, with sample sizes 20–163 and intervention durations 12–52 weeks. Participants were mostly CKD stages 2–4, with common comorbidities including hypertension, diabetes and obesity. Exercise sessions lasted 30–90 min/week, with doses ranging 208–1,869 MET‑min. Compared with usual care, RT yielded the greatest improvement in eGFR (MD = 5.77 mL/min/1.73 m²; 95% CrI 3.27–8.25), followed by AT (MD = 3.66; 95% CrI 1.25–6.03), whereas MPA showed a smaller, non-significant effect (MD = 1.76; 95% CrI − 0.33–3.79). A non-linear dose–response was observed, with meaningful gains at ~ 264–1,302 MET‑min/week, peaking at ~ 1,200 MET‑min/week. Findings for MPA should be interpreted cautiously and should not be overgeneralized to all specific exercise forms within this category. RT and AT improve eGFR in adults with non-dialysis CKD, with RT showing the greatest effect. A non-linear dose–response indicates moderate weekly volumes offer the most benefit, beyond which gains plateau.