Background: Dyspnea is a prevalent, debilitating symptom in advanced Chronic Kidney Disease (CKD), often driven by complex hydro-mechanical and uremic pathways. While pharmacological volume management is standard, fluid removal alone frequently fails to rapidly resolve respiratory distress, highlighting an unmet need for multimodal clinical interventions.

Objective: This prospective observational pilot case series evaluated the clinical utility and mechanical efficacy of pairing rigorous fluid kinetics tracking (via serial daily weights) with structured chest physiotherapy (CPT) to relieve dyspnea and optimize oxygenation in hospitalized advanced CKD patients.

Methods: Ten consecutive patients with advanced CKD (Stage 3, n =4 ; Stage 4, n=6 ) presenting with severe dyspnea (Modified Medical Research Council [mMRC] Grade ≥3 ) were observed over a 5-day standardized protocol. Patients underwent a comprehensive diagnostic battery (radiology, echocardiography, and sputum analysis) and were managed using a dual-track protocol: Track A involved calibrated daily morning weight checks to monitor fluid shifts, and Track B comprised twice-daily CPT sessions (high-Fowler’s positioning, diaphragmatic/pursed-lip re-education, and incentive spirometry).

Results: The protocol successfully tracked a mean weight loss of 3.84±0.89 kg  by Day 5, reflecting systemic interstitial fluid clearance. Concurrently, the cohort demonstrated significant respiratory stabilization: the mean modified Medical Research Council (mMRC) dyspnea score decreased from 3.4±0.52  to 1.0±0.67 , mean respiratory rate dropped from 26.8±3.1  to 17.4±1.5  breaths per minute, and mean room-air SpO2  improved from 89.2%±2.4%  to 96.5%±1.6% . Notably, 80% (n=8 ) of patients reported immediate subjective relief within 30 minutes of their initial positioning and breathing session, preceding maximum physical fluid loss.

Conclusion: Monitoring serial weight fluctuations provides a reliable, real-time assessment of fluid velocity in advanced CKD. When paired with targeted chest physiotherapy, this non-invasive, interdisciplinary approach offers safe, immediate, and sustained relief from dyspnea by unloading diaphragmatic restriction and improving alveolar recruitment. These pilot findings generate a strong clinical rationale for larger randomized controlled trials.