Physical activity in patients receiving peritoneal dialysis: a systematic evaluation and meta-analysis

Exercise has been proven to be beneficial for both the general population and individuals with chronic diseases. However, the specific effects of physical activity on patients undergoing peritoneal dialysis (PD) remain unclear.

This systematic review and meta-analysis aims to evaluate the effects of physical exercise on quality of life, physical function, pain, energy, sleep, and malnutrition-inflammation-atherosclerosis (MIA) syndrome in PD patients.

We conducted a systematic search of PubMed, EMBASE, Web of science and the Cochrane Library for randomized controlled trials (RCTs) that compared routine care with physical activity interventions in patients with chronic kidney disease (CKD) undergoing PD. The search covered studies from database inception to December 2023. Outcomes were reported as mean differences (MD) with standard deviations (SD) and 95% confidence intervals (CI). All statistical analyses were performed using RevMan version 5.3.

We included nine RCTs involving 398 patients, with 199 (50%) randomized to the physical activity group. Follow-up ranged from 12 weeks to 6 months. Compared to routine care, the exercise group showed significant improvements in BKD (MD 9.98; 95% CI 2.14-17.82; p = 0.01), EKD (MD 7.15; 95% CI - 0.13-14.43; p = 0.05), social support (MD 9.51; 95% CI 0.27-18.75; p = 0.04), social interaction (MD 6.91; 95% CI 0.82-13.00; p = 0.03), and physical pain (MD 14.35; 95% CI 3.60-25.10; p = 0.009). Qualitative analysis revealed a significant decrease in homeostatic model assessment of insulin resistance (HOMA-IR), a significant increase in C-reactive protein (CRP), and improvements in sitting and standing tests (CS-30, FTTST, SS5) in the exercise group (p < 0.05).

This study represents the first meta-analysis comparing usual care with exercise interventions in PD patients. The findings indicate that exercise is a viable therapeutic option. Future research should prioritize the development of tailored exercise programs to optimize PD management.