Abstract / Summary
Abstract Background/Objectives Frailty is common among adults receiving maintenance hemodialysis (HD) or peritoneal dialysis (PD) and is associated with mortality, hospitalization, impaired physical function, and reduced quality of life. In a multimorbid population vulnerable to polypharmacy and treatment burden, non-pharmacological approaches may be clinically relevant. This narrative review aimed to describe and critically discuss evidence published from January 2020 to December 2025 on non-pharmacological interventions and frailty-related outcomes in adults receiving maintenance dialysis. Methods A structured literature search was conducted in PubMed/MEDLINE and Google Scholar, supplemented by reference-list screening. English-language studies involving adult HD or PD populations were considered if they addressed frailty, pre-frailty, physical function, sarcopenia, nutritional vulnerability, oral frailty, or non-pharmacological interventions including exercise, nutrition, rehabilitation, and multidisciplinary care. Eligible publications included systematic reviews, meta-analyses, randomized and non-randomized studies, feasibility studies, and observational cohorts. Owing to heterogeneity in populations, dialysis modalities, frailty definitions, interventions, and outcomes, findings were narratively appraised without quantitative pooling. Results Exercise was the most frequently studied intervention, particularly in HD. Intradialytic aerobic and resistance programs were associated with improvements in selected frailty-related measures, including frailty scores, gait speed, grip strength, walking capacity, fatigue, and physical performance. Observational data suggested that greater low-intensity activity on non-dialysis days was associated with better survival, although causality cannot be inferred. Neuromuscular electrical stimulation appeared feasible in small studies of patients unable to undertake voluntary exercise. Evidence in PD was limited but suggested that home-based exercise is feasible and that exercise capacity is prognostically relevant. Nutritional vulnerability, protein-energy wasting, sarcopenia, and oral frailty were consistently associated with frailty; screening tools such as appetite questionnaires and bioimpedance-derived phase angle may assist risk identification. Conclusion Recent literature suggests that exercise-based interventions may improve selected frailty-related outcomes, particularly in HD. Nutritional and oral-health assessment and multidisciplinary rehabilitation may provide complementary support. However, interpretation is limited by heterogeneous populations, frailty measures, interventions, and outcomes, as well as limited PD-specific evidence. Future studies should use standardized, dialysis-appropriate frailty screening tools and evaluate individualized exercise and nutrition prescriptions tailored to functional capacity, nutritional risk, symptoms, dialysis modality, and patient goals.