Aims <p>To understand the current status and influencing factors of patient activation among peritoneal dialysis (PD) patients, and to explore whether social support indirectly influences patient activation through psychological distress.</p> Method <p>This study adopted a cross-sectional research design and enrolled 232 PD patients in a peritoneal dialysis center of hospital between March and June 2025. The research tools included a demographic characteristics questionnaire, the perceived social support scale, the Kessler psychological distress scale and the patient activation measure-13 item.</p> Results <p>Patient activation was positively correlated with social support (<i>r</i> = 0.68, <i>P</i> &lt; 0.01) and negatively correlated with psychological distress (<i>r</i> = -0.55, <i>P</i> &lt; 0.01). Psychological distress mediated the relationship between social support and patient activation in PD patients, accounting for 16.28% of the total effect. Monthly household income, complications, social support and psychological distress were important factors influencing patient activation in PD patients. Age, gender, monthly household income, complications, psychological distress and social support explained 46.6% of patient activation.</p> Conclusions <p>This study identified the factors influencing activation in PD patients and revealed that social support has a reinforcing effect on patient activation by alleviating psychological distress. Based on these, an evidence-based intervention programs integrating social support and psychological distress should be developed to provide a theoretical basis and practical approach for optimizing the comprehensive management of PD.</p> Clinical trial number <p>Not applicable.</p>