Physical Activity in Patients Treated With Peritoneal Dialysis: A Systematic Review and Meta-analysis

BACKGROUND: Exercise has been shown to be of benefit in the general population and in patients with chronic diseases. Despite a lack of compelling evidence, patients with end-stage kidney disease (ESKD) treated with peritoneal dialysis (PD) are often discouraged from participating in exercise programs that include weight lifting due to concerns about the development of hernias and leaks. The actual effects of physical activity with or without structured exercise programs for patients on PD remain unclear. OBJECTIVE: To determine the risks and benefits of physical activity in the ESKD population treated with PD. DESIGN: Systematic review and meta-analysis. SETTING: Included all studies that met our criteria regardless of country of origin. PATIENTS: Adult patients with ESKD treated with PD. MEASUREMENTS: Descriptive and quantitative analysis of our primary and secondary outcome variables. METHODS: We searched MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials for observational and interventional studies examining the effects of physical activity in patients on PD. A systematic review and meta-analysis was conducted of the identified studies. The primary outcomes of interest included patient-centered outcomes of mental health, physical functioning, fatigue, quality of life, and adverse events. Secondary outcomes included nutritional measures, lipid profile, blood pressure changes, maximum heart rate, resting heart rate, maximal oxygen consumption, muscle development, cognitive function, and markers of inflammation. RESULTS: Of 1828 studies identified by the literature search, 12 met the inclusion criteria including 6 interventional and 6 observational studies. There was limited information on the patient important outcomes. However, there is some evidence for improvements in burden of kidney disease, physical function, and some mental health measures with physical activity. LIMITATIONS: Lack of well-designed randomized controlled trials impaired our ability to determine the benefits and risks of increasing physical activity. CONCLUSIONS: There is limited evidence of benefit with increased levels of physical activity in PD patients. Further research is needed to define the exercise program that is likely to be of most benefit to patients treated with PD.