The Healing Steps: Walking to Slow Down Kidney Disease Progression

Andrew Kowalski, MD, FASN

Introduction

In the landscape of CKD management, medication and diet often take center stage. Unfortunately, I strongly believe that we are missing the boat on kidney function preservation and health. Another vital and profoundly accessible intervention is frequently overlooked; the simple act of walking. As a low-impact, scalable, and cost-free form of physical activity, walking offers powerful systemic benefits.

In our world, often led by "fitness gurus," the information about what fitness prescription is frequently misleading and often adulterated by unnecessary additonal work. Our bodies are designed to conserve energy, which is why being a couch potato is such an easy rut to fall into. However, our bodies are also incredibly adaptable and can quickly "switch" to a fat burning and muscle building machine with surprising less effort than all the "gurus" claim is needed.

Thankfully recent studies have focused on the benefit of walking. When skimming through the literature, it is practically unacceptable not to suggest this simple fitness method to all patients.

Walking benefits cardiovascular health, optimizes metabolic control, enhances psychological well-being, and reduces inflammation, all of which are critical in slowing CKD progression. This blog explores the scientific evidence and practical considerations for incorporating walking into CKD care plans.

The CKD and Physical Inactivity Paradox

CKD is associated with fatigue, muscle wasting (sarcopenia), and decreased cardiorespiratory fitness, often leading to a downward spiral of physical inactivity. Ironically, this very inactivity accelerates the disease it seeks to accommodate. Sedentary lifestyles contribute to worsening blood pressure, insulin resistance, obesity, inflammation, and cardiovascular disease—the very comorbidities that drive CKD progression.

Walking emerges as a simple antidote to this spiral. It is gentle on the joints, requires no special equipment, and is adaptable to varying physical capacities.

Key Benefits of Walking in CKD

1. Blood Pressure Regulation

Hypertension is both a cause and a consequence of CKD. Studies show that moderate-intensity walking can reduce systolic blood pressure by 5–10 mmHg, improving glomerular hemodynamics and reducing intraglomerular pressure. This helps prevent further damage to nephrons.

So what is "moderate intensity" walking? We as clinicians frequently quote our literatue without giving a proper explanation to our patients. the truth is that the definition changes depending on the physical abilities of the patient. I would bet that if polled, more than half to healthcare providers could not come up with a proper definition.

Moderate Intensity walking is:

• Walking with a pace of 3-4 miles per hour at surface level

• Approximately 100-120 steps per minute

• Feeling slightly out of breath, but still able to hold a conversation

✅ Clinical Insight: A consistent 30-minute walk, five days a week, has been linked to improved blood pressure control in stage 3 and 4 CKD patients.

2. Improved Glycemic Control

Walking enhances insulin sensitivity and promotes glucose uptake in skeletal muscle. A useful physiological trick for those with Diabetes. For CKD patients with diabetes, better glycemic control means reduced risk of diabetic nephropathy progression and lower proteinuria levels.

3. Weight Management and Reduced Visceral Fat

Obesity accelerates CKD through increased glomerular hyperfiltration, chronic inflammation, and insulin resistance. Walking aids in calorie expenditure, particularly targeting visceral adiposity, which is metabolically harmful and inflammatory.

So how does this work? Running is often described as the goal standard of fitness and if you push even harder HIIT (high interval intensity training) should be superior...not actually true, sorry to say.

Walking accelerates fat burning by acting as steady state cardio and primaraly utilizing fat as fuel. Higher intensity cardio utilizes sugar as fuel as a quick energy source. When you walk at a moderate pace your body doesn't rely on utilizing glycogen (stored carbohydrates as fuel). This allows the body to tap into the stored fat for longer sustained energy usage. When the intensity is decreased, sugar isn't needed this allows the body to tap into the stored fat for longer sustained energy usage and becomes the primary fuel source. Walking also tends to be done for a longer period of time allowing for greater chaloric brun in the long run.

4. Reduced Systemic Inflammation

Chronic low-grade inflammation plays a central role in CKD progression. Walking has been shown to downregulate pro-inflammatory cytokines such as IL-6 and TNF-α, and upregulate anti-inflammatory markers like IL-10.

🔬 Study Highlight: A 12-week walking intervention reduced CRP (C-reactive protein), a marker of inflammation, levels in CKD patients by up to 25%.

5. Cardiovascular Protection

Unfortunately, cardiovascular disease is the leading cause of death in CKD patients. Walking strengthens cardiac output, reduces arterial stiffness, and improves cholesterol profiles—all of which mitigate cardiovascular risks that could otherwise worsen kidney function through decreased perfusion and ischemia (poor blood delivery).

6. Preservation of Muscle Mass and Function

Sarcopenia and frailty are prevalent in CKD and often go hand in hand. Walking promotes muscle protein synthesis, enhances mitochondrial function, and reduces the risk of falls and disability. The preservation of lean mass also correlates with better renal outcomes and reduced hospitalizations.

7. Psychological Resilience

Depression and anxiety are common among CKD patients and can reduce adherence to treatment and self-care. Walking, especially in natural environments, improves serotonin and dopamine levels, leading to enhanced mood, reduced stress, and improved sleep, all of which benefit immune function and inflammation control.

Here is a visual chart highlighting the key benefits of walking and their relative impact on slowing CKD progression. Each factor—such as blood pressure control and reduced inflammation—contributes significantly to better renal outcomes, emphasizing walking as a powerful, multifaceted intervention. Let me know if you’d like this chart in a printable format or with added patient education notes. 

Evidence from Clinical Studies

Study	Participants	Duration	Walking Protocol	Outcomes
Chen et al., 2014	225 CKD patients Stage 3–5	6 months	≥30 min/day, 3–5x/week	Reduced eGFR decline rate and fewer dialysis initiations
Song et al., 2017	95 hemodialysis patients	3 months	4,000+ steps/day	Lower CRP levels and improved physical performance
Hiraki et al., 2013	121 CKD patients	1 year	Walking ≥2x/week	33% lower risk of progression to ESRD

Practical Recommendations

1. Start Slow: Begin with 10–15 minutes per day and gradually increase duration and frequency.

2. Monitor Intensity: Aim for moderate intensity—brisk walking where one can talk but not sing.

3. Track Progress: Use a pedometer or smartphone app to set and meet daily step goals (start with 3,000–5,000 steps).

4. Walk with Purpose: Incorporate walking into daily routines—walk after meals, during breaks, or with a partner.

5. Safety First: Wear proper footwear, hydrate, and avoid extreme weather. CKD patients should consult a healthcare provider before starting a new routine, especially if comorbidities exist.

Special Considerations

• Dialysis Patients: Walking on non-dialysis days, or short walks post-dialysis (if tolerated), can boost recovery and prevent post-dialysis fatigue, which is a large side-effect and complaint among dialysis patients.

• Elderly or Frail Individuals: Use assistive devices if needed. Even short, frequent walks can yield benefits.

• Advanced CKD (Stage 4–5): Monitor for orthostatic hypotension or anemia-related fatigue; adjust pace accordingly.

Conclusion: Every Step Counts

Walking is more than a form of exercise, it is a therapeutic intervention that integrates seamlessly into everyday life. For patients with CKD, it serves as a catalyst for better blood pressure, glycemic control, muscle strength, mental health, and reduced inflammation, all of which converge to slow the decline in kidney function.

A prescription for walking, gentle, regular, and purposeful should be just as routine as prescribing antihypertensives or dietary changes.

In the journey of kidney care, every step matters.

Final Thoughts

• Goal: 30 minutes per day, 5 days a week

• Step Target: 5,000–7,000 steps/day

• Tip: Walk after meals to reduce blood sugar spikes

• Inspiration: “Walking is man’s best medicine.” — Hippocrates