Mortality of Peritoneal Dialysis versus Hemodialysis in Older Adults: An Updated Systematic Review and Meta-Analysis.

IF 3.1 3区医学 Q3 GERIATRICS & GERONTOLOGY

Gerontology Pub Date : 2024-01-01 Epub Date: 2024-02-07 DOI:10.1159/000536648

Linan Cheng, Nan Hu, Di Song, Yuqing Chen

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引用次数: 0

Abstract

Introduction: The optimal choice of dialysis modality remains contentious in older adults threatened by advanced age and high risk of comorbidities.

Methods: We conducted a systematic review and meta-analysis of cohort and case-control studies to assess mortality risk between peritoneal dialysis (PD) and hemodialysis (HD) in older adults using PubMed, Embase, and the Cochrane Library database from inception to June 1, 2022. The outcome of interest is all-cause mortality.

Results: Thirty-one eligible studies with >774,000 older patients were included. Pooled analysis showed that PD had a higher mortality rate than HD in older dialysis population (HR 1.17, 95% CI: 1.10-1.25). When stratified by co-variables, our study showed an increased mortality risk of PD versus HD in older patients with diabetes mellitus or comorbidity who underwent longer dialysis duration (more than 3 years) or who started dialysis before 2010. However, definitive conclusions were constrained by significant heterogeneity.

Conclusion: From the survival point of view, caution is needed to employ PD for long-term use in older populations with diabetes mellitus or comorbid conditions. However, a tailored treatment choice needs to take account of what matters to older adults at an individual level, especially in the context of limited survival improvements and loss of quality of life. Further research is still awaited to conclude this topic.

查看原文本刊更多论文

老年人腹膜透析与血液透析的死亡率对比：最新系统回顾与元分析》。

导言：对于受到高龄和高合并症风险威胁的老年人来说，透析方式的最佳选择仍然存在争议：我们使用 PubMed、Embase 和 Cochrane Library 数据库对从开始到 2022 年 6 月 1 日的队列研究和病例对照研究进行了系统回顾和荟萃分析，以评估老年人腹膜透析 (PD) 和血液透析 (HD) 之间的死亡率风险。研究结果为全因死亡率：结果：共纳入了 31 项符合条件的研究，涉及超过 77.4 万名老年患者。汇总分析显示，在老年透析人群中，PD的死亡率高于HD（HR 1.17，95% CI 1.10-1.25）。根据共同变量进行分层后，我们的研究显示，在患有糖尿病或合并症、透析时间较长（超过 3 年）或在 2010 年前开始透析的老年患者中，透析治疗与 HD 相比死亡率风险更高。然而，由于存在显著的异质性，最终结论受到了限制：结论：从生存角度来看，对于患有糖尿病或合并症的老年人群，长期使用腹膜透析需要谨慎。然而，量身定制的治疗选择需要考虑到老年人的个体情况，尤其是在生存率提高有限和生活质量下降的情况下。这一课题还有待于进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gerontology 医学-老年医学

CiteScore

6.00

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： In view of the ever-increasing fraction of elderly people, understanding the mechanisms of aging and age-related diseases has become a matter of urgent necessity. ''Gerontology'', the oldest journal in the field, responds to this need by drawing topical contributions from multiple disciplines to support the fundamental goals of extending active life and enhancing its quality. The range of papers is classified into four sections. In the Clinical Section, the aetiology, pathogenesis, prevention and treatment of agerelated diseases are discussed from a gerontological rather than a geriatric viewpoint. The Experimental Section contains up-to-date contributions from basic gerontological research. Papers dealing with behavioural development and related topics are placed in the Behavioural Science Section. Basic aspects of regeneration in different experimental biological systems as well as in the context of medical applications are dealt with in a special section that also contains information on technological advances for the elderly. Providing a primary source of high-quality papers covering all aspects of aging in humans and animals, ''Gerontology'' serves as an ideal information tool for all readers interested in the topic of aging from a broad perspective.