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

Abstract

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.

Exercise and physical activity for people receiving peritoneal dialysis: Why not?

“…Therefore, physical function assessment and exercise program delivery are more challenging in this group than in hemodialysis patients. There has been significantly less research in PD with only six interventional trials meeting RCT standards, some of which include both PD and HD patients in the intervention . The main conclusions of this review were that there is a sad scarcity of specific PD studies and there is a positive bias in these studies.…”

“…There is very little known about the association between exercise, physical activity, and adverse events in PD patients. Although there have been infrequent case reports hypothesizing the association of exercise, leaks, hernia, or catheter malfunction, there are no reports of serious adverse events associated with exercise in the most recent exercise and PD meta‐analysis . In these exercise interventional studies, aerobic exercise and combined resistance/aerobic exercise programs were well tolerated with no reported serious adverse events.…”

“…Guidelines recommend that nephrologists encourage PD patients to increase their activity levels . However, PD patients are often discouraged from participating in exercise programs because of perceived barriers (catheter healing, dressing and water, intra‐abdominal pressure, and hernias) and uncertainty about the best exercise regimen . Unfortunately, as there are limited data, nephrologists may be reluctant to advise dialysis patients on appropriate exercise regimens.…”

“…A major barrier in understanding the physical capacity of people on PD is the lack of well‐designed randomized controlled trials (RCTs) informing clinicians. A recent systematic review investigating physical activity (PA) interventions for patients receiving PD reported only six intervention studies; participant numbers were low and the risk of bias was high . Overall, the authors concluded that while there were modest benefits in respect to quality of life, muscle mass and VO2peak, there was a need for high‐quality studies to better identify benefits and risks in PD before clinical guidelines for exercise prescription can be established.…”

Home‐based training using neuromuscular electrical stimulation in patients on continuous ambulatory peritoneal dialysis: A pilot study

“…This pilot study is the first one in which significant improvement of functional capacity and quality of life due to NMES in patients on CAPD was proven. Only minimal attention has been paid so far to RHB programs in patients on CAPD; most experience, recommendations, and results come from studies focused almost exclusively on patients on HD . This conclusion is the main asset of this pilot study.…”