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The effect of urgent-start peritoneal dialysis and urgent-start hemodialysis on clinical outcomes in patients with chronic kidney disease: an updated systematic review and meta-analysis

  • Nephrology - Review
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Abstract

Objective

Recently, urgent-start peritoneal dialysis (PD) has been suggested in place of urgent-start hemodialysis (HD) in cases of chronic kidney disease (CKD). However, the comparative effectiveness of these methods is still unclear. This study compared the outcomes of urgent-start PD and urgent-start HD in CKD patients.

Methods

Electronic searches were conducted in PubMed, EMbase, Google Scholar databases, and Cochrane Library, up to 30th July 2023 for studies reporting data on all-cause mortality. Secondary outcomes included dialysis-related infectious and mechanical complications. Risk ratios (RRs) with 95% confidence interval (CI) were calculated.

Results

Nine eligible studies involving 941 PD and 779 HD patients were analyzed. Pooled analysis demonstrated elevated risk of all-cause mortality (RR: 1.06, 95% CI: 1.02 to 1.09), dialysis-related infectious complications (RR: 1.05, 95% CI: 1.02 to 1.07), and mechanical complications (RR: 1.08, 95% CI: 1.04 to 1.13) in patients undergoing urgent-start HD than in patients on urgent-start PD.

Conclusion

Our findings indicate that CKD patients that received urgent-start HD are at increased risk of all-cause mortality and infectious, and mechanical complications that are associated with the dialysis than patients that received urgent-start PD. These findings have to be considered when making treatment decisions for patients with acute kidney injury. Better understanding of the mechanism of these differences may help to create guidelines for more informed clinical practices.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article.

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Acknowledgements

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Author notes

  1. Peixin Duan and Hailuo Zhang are co-first authors and they have contributed equally to this study.

Authors and Affiliations

  1. Department of Nephrology, Changxing People’s Hospital, Changxing County, Huzhou, Zhejiang, China

    Peixin Duan, Hailuo Zhang & Yun Zhang

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  1. Peixin Duan
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  2. Hailuo Zhang
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Contributions

PD and HZ contributed to conception of this study. All of the authors contributed to performance of work. HZ and YZ contributed to writing of the article. All authors approved this study.

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Correspondence to Yun Zhang.

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Duan, P., Zhang, H. & Zhang, Y. The effect of urgent-start peritoneal dialysis and urgent-start hemodialysis on clinical outcomes in patients with chronic kidney disease: an updated systematic review and meta-analysis. Int Urol Nephrol (2024). https://doi.org/10.1007/s11255-024-03999-6

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