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Meta-Analysis
. 2019 Nov;41(1):521-531.
doi: 10.1080/0886022X.2019.1625788.

Comparison of peritoneal dialysis with hemodialysis on survival of diabetic patients with end-stage kidney disease: a meta-analysis of cohort studies

Jing Xue  1   2 , Huihui Li  3 , Quan Zhou  4 , Shiwu Wen  5   6 , Qiaoling Zhou  3 , Wenhang Chen  3
Affiliations
Meta-Analysis

Comparison of peritoneal dialysis with hemodialysis on survival of diabetic patients with end-stage kidney disease: a meta-analysis of cohort studies

Jing Xue et al. Ren Fail. 2019 Nov.

Abstract

Aim: Renal replacement therapy was primary treatment for end stage kidney (ESRD) patients. Numbers of studies comparing peritoneal dialysis (PD) and hemodialysis (HD) yielded inconsistent results. The aim of this study was to assess the mortality risk between diabetic PD patients and those in HD. Methods: We included cohort studies comparing the risk of death among diabetic ESRD patients who receiving peritoneal dialysis or hemodialysis by searching Medline and Embase. Overall estimates were calculated using the random-effects model. Results: Seventeen studies were included in the meta-analyses. Mortality comparison between PD and HD in the diabetic ESRD patients showed PD significantly increased mortality rate (hazard ratio (HR) 1.20; 95% confidence interval (CI) 1.10-1.30; I2 = 89.1%). The overall HR using an intention-to-treat analysis was 1.23 with 95% CI (1.13 to 1.34). Meta-regression demonstrated PD patients from Asian country were associated with increase in mortality risk (coefficient = 0.270, SE = 0.112, p = .033). Limitation: The high heterogeneity in our meta-analyses undermined the robustness of the findings. Conclusion: ESRD patients with diabetes may benefit more from HD than PD.

Keywords: Hemodialysis; chronic kidney disease; diabetes; meta-analysis; peritoneal dialysis; survival.

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Figures

Figure 1.
Figure 1.
Study flow diagram.
Figure 2.
Figure 2.
Comparative mortality of diabetic ESRD patients treated with HD and PD.
Figure 3.
Figure 3.
Comparative mortality of diabetic ESRD patients treated with HD and PD by intention-to-treat principle.
Figure 4.
Figure 4.
Comparative mortality of diabetic ESRD patients treated with HD and PD by as-treated principle.
Figure 5.
Figure 5.
The summary estimates of subgroups by regions.
Figure 6.
Figure 6.
The sensitivity analysis.
Figure 7.
Figure 7.
Publication bias using Egger test.
See this image and copyright information in PMC

References

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