A Comparison of Clinical Outcomes in Urgent-Start Hemodialysis versus Urgent-Start Peritoneal Dialysis in End-Stage Renal Disease Patients: A Systematic Review and Meta-Analysis.

IF 1.8 3区医学 Q3 HEMATOLOGY

Blood Purification Pub Date : 2025-06-24 DOI:10.1159/000547049

Jia Wu, Yifu Cao, Tianzhi Wang

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引用次数: 0

Abstract

Introduction: Current evidence indicates that for patients requiring renal replacement therapy, USPD may correlate with reduced complications and lower mortality rates compared to USHD. However, there is a lack of literature specifically addressing its application and results in individuals with ESRD. A comprehensive examination and synthesis of existing research were conducted to compare fellow-up outcomes of USPD versus USHD in ESRD patients.

Methods: A comprehensive search was conducted in PubMed, Web of Science, and the Cochrane Library, and SpringerLink databases for that compare USPD to USHD before November 1, 2024. Mortality, all complications, noninfectious complications, infectious complications, bacteremia, and peritonitis were used as outcomes to compare USPD and USHD.

Results: This meta-analysis incorporated seven studies involving a total of 1,338 patients. Our findings showed no notable distinctions in peritonitis between USPD and USHD. urgent-start PD was linked to a reduced mortality rate "(OR: 0.48, 95% CI: 0.24-0.95, p < 0.05), lower all complications (OR: 0.27, 95% CI: 0.20-0.37, p < 0.05), lower noninfectious complications (OR: 0.32, 95% CI: 0.23-0.45, p < 0.05), lower infectious complications (OR: 0.29, 95% CI: 0.17-0.51, p < 0.05), lower bacteremia (OR: 0.18, 95% CI: 0.07-0.42, p < 0.05)" compared to USHD.

Conclusions: Our findings indicate that among patients with ESRD, those undergoing urgent-start PD have lower risks during the follow-up period compared to those receiving USHD. USPD is associated with significantly reduced all-cause mortality, overall complications, infectious complications, noninfectious complications, and bacteremia incidence. The results indicate that USPD could potentially function as an appropriate replacement for USHD. However, further high-quality clinical studies still are necessary to substantiate this conclusion.

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ESRD患者紧急开始血液透析与紧急开始腹膜透析的临床结果比较：系统回顾和荟萃分析。

背景：与USHD相比，需要肾脏替代治疗的USPD患者并发症更少，死亡率更低。然而，缺乏专门论述其在ESRD患者中的应用和结果的文献。目的：对现有研究进行全面的检查和综合，以比较USPD与USHD在ESRD患者中的预后。方法：在PubMed、Web of Science、Cochrane Library和SpringerLink数据库中进行综合检索，比较2024年11月1日之前紧急启动PD与紧急启动HD的比较。死亡率、所有并发症、非感染性并发症、感染性并发症、菌血症和腹膜炎作为比较USPD和USHD的结局。结果：这项荟萃分析纳入了7项研究，共涉及1338名患者。我们的研究结果显示，USPD和USHD在腹膜炎方面没有显著差异。与紧急启动的HD相比，紧急启动PD与降低死亡率（OR: 0.48, 95% CI: 0.24至0.95,p < 0.05）、降低所有并发症（OR: 0.27, 95% CI: 0.20至0.37,p < 0.05）、降低非感染性并发症（OR: 0.32, 95% CI: 0.23至0.45,p < 0.05）、降低感染性并发症（OR: 0.29, 95% CI: 0.17至0.51,p < 0.05）、降低菌血症（OR: 0.18, 95% CI: 0.07至0.42,p < 0.05）相关。结论：我们的研究结果表明，在ESRD患者中，接受紧急启动PD治疗的患者在随访期间的风险低于接受紧急启动HD治疗的患者。USPD与全因死亡率、总并发症、感染性并发症、非感染性并发症和菌血症发生率显著降低相关。结果表明，USPD可以作为USHD的合适替代品。然而，仍需要进一步的高质量临床研究来证实这一结论。

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

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.