Renal rehabilitation is a process to conduct treatments for the patients suffering from kidney disease and support to help them for their smooth achievement of social rehabilitation. Patients with dialysis-dependent kidney failure carry some additional burden of co-morbidity, such as, diabetes mellitus, hypertension, cardiovascular disease, infections, and many other. Approximately 10% of the world population is affected by chronic kidney disease and the incidence of dialysis is quite high.

p38 MAPK is a multifunctional signaling kinase. It is a responder to stress stimuli performing various pleiotropic functions ranging from maintenance of cellular homeostasis to contributing to cellular dysfunction, depending on the tissue environment. The p38 MAPK family consists of four isoforms: p38α, p38β, p38γ, and p38δ, each with distinct roles in cellular signaling. Among these, p38α is the most extensively studied and has been implicated in the pathogenesis of various diseases due to its expression in almost all cellular types [1].

Chronic kidney disease (CKD) has become a growing global health challenge, impacting over 800 million individuals worldwide [1]. Numerous evidences have shown that women are more resistant to CKD than men before menopause, however this beneficial effect is diminished in those with post-menopause, highlighting the pivotal role of estrogen in kidney disease [2-5].

The number of individuals with all-stage chronic kidney disease (CKD) reached almost 700 million in 2017, which is more people than those with diabetes, osteoarthritis, chronic obstructive pulmonary disease (COPD), asthma, or depressive disorders [1]. A multitude of studies have been published in the field of CKD based on patho-physiological considerations, screening, etiological factors, clinical observations, targeted therapeutic interventions, but very little is known about the fate of a patient, who has CKD  and who is followed for years by his treating physician and the reference nephrologist.

Diabetic kidney disease (DKD), as a common complication of diabetes mellitus, is one of the leading causes for end-stage renal disease (ESRD) in the world. Inhibitors of the renin–angiotensin–aldosterone system is widely used in DKD, but many patients still progressed to ESRD, and progress in the treatment of DKD is limited in recent years, thus more effective ways to prevent or treat DKD are necessary. Chronic hyperglycemia can induce the imbalance between the excessive reactive oxygen species (ROS) and antioxidant defense mechanisms. Increasing evidences indicated oxidative stress acts as a crucial role in the initiation and progression of DKD. It is suggested that the restoration of the balance between oxidative stress and antioxidant defense may be a hopeful drug target to prevent or treat DKD. Our meta-analysis showed that the antioxidant vitamins can benefit kidney function and systolic blood pressure in patients with diabetes and albuminuria.