Comparison of mortality and complications between urgent‐start peritoneal dialysis and urgent‐start hemodialysis: A systematic review and meta‐analysis

医学 相对风险 荟萃分析 透析 腹膜透析 观察研究 血液透析 内科学 外科 置信区间
作者
Xinyu Ding,Wenfeng Gao,Yingbo Guo,Qian Cai,Yu Bai
出处
期刊:Seminars in Dialysis [Wiley]
卷期号:35 (3): 207-214 被引量:10
标识
DOI:10.1111/sdi.13001
摘要

Abstract The advantages of urgent‐start peritoneal dialysis (PD) vis‐à‐vis urgent‐start hemodialysis (HD) are not clear. We performed a systematic review and meta‐analysis of studies comparing the two modalities. Databases of PubMed, Embase, Ovoid, and Google Scholar were searched up to November 1, 2020. The primary outcome was mortality, and secondary outcomes were dialysis‐related infectious complications and mechanical complications. Risk ratios (RRs) were calculated for all outcomes. Seven studies were included. The pooled analysis revealed a statistically significant reduced risk of all‐cause mortality in patients undergoing urgent‐start PD as compared to urgent‐start HD (RR: 0.61, 95% confidence interval [CI] [0.40, 0.94], I 2 = 56.34%). A meta‐analysis of dialysis‐related infectious complications indicated no statistically significant difference between the two modalities (RR: 0.66, 95% CI [0.29, 1.50], I 2 = 69.62%). Our analysis revealed a statistically significant reduced risk of mechanical complications in patients undergoing urgent‐start PD (RR: 0.54, 95% CI [0.40, 0.73], I 2 = 0%). To conclude, unadjusted data from observational studies are indicative of lower mortality and lower risk of mechanical complications with urgent‐start PD versus urgent‐start HD. The risk of infectious complications was not different between the two groups. Further studies with a larger sample size using propensity‐matched cohorts are needed to strengthen current evidence.
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