CoQ10 and Exercise for Mitochondrial Dysfunction in Advance Kidney Disease

Inclusion Criteria: * Subjects age 18 to 75 years * On thrice-weekly chronic hemodialysis for at least 6 months (only applicable for patients with ESRD on maintenance hemodialysis). * Clinically stable, adequately dialyzed (single-pool Kt/V \>1.2) thrice weekly, for at least 3 consecutive months prior to the study (only applicable for patients with ESRD on maintenance hemodialysis) Exclusion Criteria: * Body mass index \> 35 mg/kg2 * History of functional transplant less than 6 months prior to study * Use of immunosuppressive drugs within 1 month prior to study * Active connective tissue disease * Acute infectious disease within 1 month prior to study * AIDS (HIV seropositivity is not an exclusion criterion) * Acute myocardial infarction or cerebrovascular event within 3 months * Uncontrolled blood pressure * New or worsening mitral regurgitation murmur * Hypotension, bradycardia, or tachycardia * Prolonged ongoing (greater than 20 minutes) angina at rest * Angina at rest with transient ST changes greater than 0.05 mV on ECG * Sustained ventricular tachycardia on ECG * Elevated cardiac enzymes (e.g., troponin Tor I greater than 0.1mg/ml) * Advanced liver disease, with a modified Child-Turcotte-Pugh score equal or greater than 10. * Gastrointestinal dysfunction requiring parental nutrition * Active malignancy excluding basal cell carcinoma of the skin * Ejection fraction less than 30% * Pre-dialysis potassium repeatedly higher than 5.5 mmol/L (confirmed on a repeated blood draw) * Anticipated live donor kidney transplant * History of poor adherence to hemodialysis or medical regimen * Inability to provide consent * Subjects with cardiac pacemaker, artificial heart valve, any metallic implant, permanent tattoo, or any retained foreign metallic bodies. * Inability to perform exercise * Contraindication for exercise such as electrolyte abnormalities, uncontrolled arrhythmias, or pulmonary congestion.