Mortality and mode of dialysis: meta-analysis and systematic review
Abstract Background The global use of kidney replacement therapy (KRT) has increased, mirroring the incidence of acute kidney injury and chronic kidney disease. Despite its growing clinical usage, patient outcomes with KRT modalities remain controversial. In this meta-analysis, we sought to compare...
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-023-03435-4 |
| _version_ | 1827388713118728192 |
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| author | Subhash Chander Sindhu Luhana FNU Sadarat Om Parkash Zubair Rahaman Hong Yu Wang FNU Kiran Abhi Chand Lohana FNU Sapna Roopa Kumari |
| author_facet | Subhash Chander Sindhu Luhana FNU Sadarat Om Parkash Zubair Rahaman Hong Yu Wang FNU Kiran Abhi Chand Lohana FNU Sapna Roopa Kumari |
| author_sort | Subhash Chander |
| collection | DOAJ |
| description | Abstract Background The global use of kidney replacement therapy (KRT) has increased, mirroring the incidence of acute kidney injury and chronic kidney disease. Despite its growing clinical usage, patient outcomes with KRT modalities remain controversial. In this meta-analysis, we sought to compare the mortality outcomes of patients with any kidney disease requiring peritoneal dialysis (PD), hemodialysis (HD), or continuous renal replacement therapy (CRRT). Methods The investigation was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed (MEDLINE), Cochrane Library, and Embase databases were screened for randomized trials and observational studies comparing mortality rates with different KRT modalities in patients with acute or chronic kidney failure. A random-effects model was applied to compute the risk ratio (RR) and 95% confidence intervals (95%CI) with CRRT vs. HD, CRRT vs. PD, and HD vs. PD. Heterogeneity was assessed using I 2 statistics, and sensitivity using leave-one-out analysis. Results Fifteen eligible studies were identified, allowing comparisons of mortality risk with different dialytic modalities. The relative risk was non-significant in CRRT vs. PD [RR = 0.95, (95%CI 0.53, 1.73), p = 0.92 from 4 studies] and HD vs. CRRT [RR = 1.10, (95%CI 0.95, 1.27), p = 0.21 from five studies] comparisons. The findings remained unchanged in the leave-one-out sensitivity analysis. Although PD was associated with lower mortality risk than HD [RR = 0.78, (95%CI 0.62, 0.97), p = 0.03], the significance was lost with the exclusion of 4 out of 5 included studies. Conclusion The current evidence indicates that while patients receiving CRRT may have similar mortality risks compared to those receiving HD or PD, PD may be associated with lower mortality risk compared to HD. However, high heterogeneity among the included studies limits the generalizability of our findings. High-quality studies comparing mortality outcomes with different dialytic modalities in CKD are necessary for a more robust safety and efficacy evaluation. |
| first_indexed | 2024-03-08T16:22:53Z |
| format | Article |
| id | doaj.art-f127addfd20e455bbda3c994cf681ee5 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-03-08T16:22:53Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-f127addfd20e455bbda3c994cf681ee52024-01-07T12:15:20ZengBMCBMC Nephrology1471-23692024-01-0125111310.1186/s12882-023-03435-4Mortality and mode of dialysis: meta-analysis and systematic reviewSubhash Chander0Sindhu Luhana1FNU Sadarat2Om Parkash3Zubair Rahaman4Hong Yu Wang5FNU Kiran6Abhi Chand Lohana7FNU Sapna8Roopa Kumari9Department of Medicine, Icahn School of Medicine at Mount SinaiDepartment of Medicine, AGA khan University HospitalDepartment of Medicine, University at BuffaloDepartment of Medicine, Montefiore Medical CentreDepartment of Medicine, University at BuffaloDepartment of Medicine, Icahn School of Medicine at Mount SinaiDepartment of Pathology, Northwell Health Staten Island University HospitalDepartment of Medicine, WVU, Camden Clark Medical CentreDepartment of Pathology, Albert Einstein School of Medicine, Montefiore Medical CentreDepartment of Pathology, Icahn School of Medicine at Mount SinaiAbstract Background The global use of kidney replacement therapy (KRT) has increased, mirroring the incidence of acute kidney injury and chronic kidney disease. Despite its growing clinical usage, patient outcomes with KRT modalities remain controversial. In this meta-analysis, we sought to compare the mortality outcomes of patients with any kidney disease requiring peritoneal dialysis (PD), hemodialysis (HD), or continuous renal replacement therapy (CRRT). Methods The investigation was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed (MEDLINE), Cochrane Library, and Embase databases were screened for randomized trials and observational studies comparing mortality rates with different KRT modalities in patients with acute or chronic kidney failure. A random-effects model was applied to compute the risk ratio (RR) and 95% confidence intervals (95%CI) with CRRT vs. HD, CRRT vs. PD, and HD vs. PD. Heterogeneity was assessed using I 2 statistics, and sensitivity using leave-one-out analysis. Results Fifteen eligible studies were identified, allowing comparisons of mortality risk with different dialytic modalities. The relative risk was non-significant in CRRT vs. PD [RR = 0.95, (95%CI 0.53, 1.73), p = 0.92 from 4 studies] and HD vs. CRRT [RR = 1.10, (95%CI 0.95, 1.27), p = 0.21 from five studies] comparisons. The findings remained unchanged in the leave-one-out sensitivity analysis. Although PD was associated with lower mortality risk than HD [RR = 0.78, (95%CI 0.62, 0.97), p = 0.03], the significance was lost with the exclusion of 4 out of 5 included studies. Conclusion The current evidence indicates that while patients receiving CRRT may have similar mortality risks compared to those receiving HD or PD, PD may be associated with lower mortality risk compared to HD. However, high heterogeneity among the included studies limits the generalizability of our findings. High-quality studies comparing mortality outcomes with different dialytic modalities in CKD are necessary for a more robust safety and efficacy evaluation.https://doi.org/10.1186/s12882-023-03435-4HemodialysisPeritoneal dialysisCRRTContinuous kidney replacement therapy |
| spellingShingle | Subhash Chander Sindhu Luhana FNU Sadarat Om Parkash Zubair Rahaman Hong Yu Wang FNU Kiran Abhi Chand Lohana FNU Sapna Roopa Kumari Mortality and mode of dialysis: meta-analysis and systematic review BMC Nephrology Hemodialysis Peritoneal dialysis CRRT Continuous kidney replacement therapy |
| title | Mortality and mode of dialysis: meta-analysis and systematic review |
| title_full | Mortality and mode of dialysis: meta-analysis and systematic review |
| title_fullStr | Mortality and mode of dialysis: meta-analysis and systematic review |
| title_full_unstemmed | Mortality and mode of dialysis: meta-analysis and systematic review |
| title_short | Mortality and mode of dialysis: meta-analysis and systematic review |
| title_sort | mortality and mode of dialysis meta analysis and systematic review |
| topic | Hemodialysis Peritoneal dialysis CRRT Continuous kidney replacement therapy |
| url | https://doi.org/10.1186/s12882-023-03435-4 |
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