Physical Function, Exercise, and Clinical Outcomes in Peritoneal Dialysis: A Narrative Review

Background : Peritoneal dialysis (PD) is a home-based kidney replacement therapy, yet many patients experience low physical activity, reduced muscle strength, and impaired cardiorespiratory fitness. Contemporary evidence increasingly links these functional deficits to clinically meaningful outcomes. Objective : This study aims to review studies published from 2020 to present to summarize (i) the burden and assessment of impaired physical function in PD, (ii) associations with clinical outcomes, and (iii) effects of exercise interventions. Methods : Based on PubMed dataset, a contemporary narrative review of peer-reviewed literature (2020-present) evaluating sarcopenia/frailty, objective and patient-reported physical function measures (e.g., handgrip strength, Short Physical Performance Battery, timed up-and-go, 6-minute walk distance, incremental shuttle walk test), and structured exercise interventions in adults treated with PD. Results : Impaired physical function is common in PD and variably defined across studies, contributing to heterogeneous prevalence estimates of sarcopenia and frailty. Lower physical activity and poorer performance on objective tests are consistently associated with higher risks of mortality, hospitalization, and PD technique failure, with aerobic capacity measures showing particularly strong prognostic value in several cohorts. Exercise interventions (aerobic, resistance, or combined; often home-based) are generally feasible and safe, and improve functional performance and health-related quality of life, with additional benefits for fatigue, mood, and pain; effects on hard endpoints remain uncertain. Conclusions : Since 2020, evidence supports physical function as a key risk marker in PD and exercise as an effective strategy to improve function and patient-reported outcomes. Larger, longer trials and implementation-focused research are needed to determine effects on survival and technique outcomes and to embed routine functional assessment and exercise prescription into PD care.