Relationship between Exercise and the Occurrence of Abdominal Wall Complications among Patients on Peritoneal Dialysis

Background: Concerns about the development of abdominal wall complications are one of reasons for physical inactivity among peritoneal dialysis patients, but there was no direct evidence to confirm the relationship between exercise and abdominal wall complications. In the general population, the relationship between exercise and abdominal wall complications such as hernias remains controversial. This study aims to explore the relationship between exercise and abdominal pressure complications in peritoneal dialysis population. Methods: A retrospective data analysis of a prospective cohort. Incident and prevalent PD patients between January 2016 and April 2019 were recruited. Abdominal wall complications related to increased intra-abdominal pressure, including hernia, hydrothorax, etc. were recorded during follow-up. Exercise characteristics were collected by outpatient questionnaire, including exercise or not, type of sports, exercise duration and exercise intensity. Competing risk model were used to assess the predictive power of exercise data in the occurrence of abdominal wall complications. The subgroups analysis according to age, gender, diabetes, BMI and eIPP were also performed. Results: During the median follow-up of 46.0 months among the 475 PD patients, 33 (6.9%) patients developed abdominal wall complications. Totally 377(79.4%) patients had regular exercise. Walking was the major exercise form among 99.5% participants. Only 2 patients combined aerobic and impedance exercise. The median exercise duration per week was 210.0 (140.0, 350.0) minutes. About 52% patients having exercise intensity below fairly light. None of exercise characteristics including exercise or not, exercise duration per week, exercise intensity was found to be associated with abdominal wall complications in univariate or multivariate competing risk analysis. Similarly, no significant prognostic value was found in any subgroup analyses. The number of patients involved in impedance exercise was too small to do further analyse. Conclusion: This study confirmed for the first time that aerobic exercise in appropriate duration and intensity didn’t increase the risk of abdominal wall complications in peritoneal dialysis patients. Further research on resistance exercise and high-intensity exercise need to be further explored in the PD population.