Use of peritoneal dialysis in AKI: a systematic review

Abstract

Background and objectives: The role of peritoneal dialysis in the management of AKI is not well defined, although it remains frequently used, especially in low-resource settings. A systematic review was performed to describe outcomes in AKI treated with peritoneal dialysis and compare peritoneal dialysis with extracorporeal blood purification, such as continuous or intermittent hemodialysis.

Design, setting, participants, & measurements: MEDLINE, CINAHL, and Central Register of Controlled Trials were searched in July of 2012. Eligible studies selected were observational cohort or randomized adult population studies on peritoneal dialysis in the setting of AKI. The primary outcome of interest was all-cause mortality. Summary estimates of odds ratio were obtained using a random effects model.

Results: Of 982 citations, 24 studies (n=1556 patients) were identified. The overall methodological quality was low. Thirteen studies described patients (n=597) treated with peritoneal dialysis only; pooled mortality was 39.3%. In 11 studies (7 cohort studies and 4 randomized trials), patients received peritoneal dialysis (n=392, pooled mortality=58.0%) or extracorporeal blood purification (n=567, pooled mortality=56.1%). In the cohort studies, there was no difference in mortality between peritoneal dialysis and extracorporeal blood purification (odds ratio, 0.96; 95% confidence interval, 0.53 to 1.71). In four randomized trials, there was also no difference in mortality (odds ratio, 1.50; 95% confidence interval, 0.46 to 4.86); however, heterogeneity was significant (I(2)=73%, P=0.03).

Conclusions: There is currently no evidence to suggest significant differences in mortality between peritoneal dialysis and extracorporeal blood purification in AKI. There is a need for good-quality evidence in this important area.

Figure 1.

Flow chart of the article selection process based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) (12). EBP, extracorporeal blood purification; PD, peritoneal dialysis.

Figure 2.

Distribution of studies included for review. The number of studies is illustrated according to (A) geographical region of origin and (B) year of study publication. Australia is included under Asia–Pacific. EBP, extracorporeal blood purification; PD, peritoneal dialysis.

Figure 3.

Effect of renal replacement therapy modality on mortality in patients with AKI grouped by study design. The pooled odds ratio with 95% confidence interval (95% CI) was calculated using the Mantel–Haenszel (M-H) random effects model. (A) Cohort studies. (B) Randomized studies. EBP, extracorporeal blood purification; PD, peritoneal dialysis.