The Safety of Peritoneal Dialysis Physical Activity Programs in the Era of Advancing American Kidney Health.

To the Editor:

Seliger has provided an excellent concise editorial identifying possible uncertainties and challenges in designing peritoneal dialysis (PD) exercise clinical trials. We agree that the lack of clinical trials in PD has contributed to an absence of PD exercise programs in the United States. Increased activity and exercise can lead to increased physical function and improved independence, increasing the potential to keep patients at home receiving PD. This can maintain the momentum of the Advancing American Kidney Health Executive Order.

This follow-up letter identifies uncertainties and challenges related to PD exercise research that have been recently addressed. Most PD patients believed that daytime dialysate dwells, the PD catheter, vascular accesses, and comorbid conditions were not barriers to exercise. Furthermore, the concern regarding core muscle safety has consistently been alleviated by the absence of adverse events in recent resistance exercise studies.3, 4, 5

We agree that the benefits of exercise programs may be minimal for some PD patients. Therefore, research is required to guide us on which patients to focus on to increase efficiency, by channeling resources to those who will benefit the most. Involving exercise professionals in dialysis centers to assess patients and design individualized exercise programs is one strategy to overcome these challenges.

To further understand the benefits and barriers, we recommend both efficacy and effectiveness studies, focusing on the prefrail and frail PD patients to continue the momentum toward increasing the activity, physical function, and quality of life of people managing their PD independently at home.