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Sun X, McKeaveney C, Shields J, Chan CP, Henderson M, Fitzell F, Noble H, O'Neill S. Rate and reasons for peritoneal dialysis dropout following haemodialysis to peritoneal dialysis switch: a systematic review and meta-analysis. BMC Nephrol 2024; 25:99. [PMID: 38493084 PMCID: PMC10943899 DOI: 10.1186/s12882-024-03542-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Patient experiences and survival outcomes can be influenced by the circumstances related to dialysis initiation and subsequent modality choices. This systematic review and meta-analysis aimed to explore the rate and reasons for peritoneal dialysis (PD) dropout following haemodialysis (HD) to PD switch. METHOD This systematic review conducted searches in four databases, including Medline, PubMed, Embase, and Cochrane. The protocol was registered on PROSPERO (study ID: CRD42023405718). Outcomes included factors leading to the switch from HD to PD, the rate and reasons for PD dropout and mortality difference in two groups (PD first group versus HD to PD group). The Critical Appraisal Skills Programme (CASP) checklist and the GRADE tool were used to assess quality. RESULTS 4971 papers were detected, and 13 studies were included. On meta-analysis, there was no statistically significant difference in PD dropout in the PD first group (OR: 0.81; 95%CI: 0.61, 1.09; I2 = 83%; P = 0.16), however, there was a statistically significant reduction in the rate of mortality (OR: 0.48; 95%CI: 0.25, 0.92; I2 = 73%; P = 0.03) compared to the HD to PD group. The primary reasons for HD to PD switch, included vascular access failure, patient preference, social issues, and cardiovascular disease. Causes for PD dropout differed between the two groups, but inadequate dialysis and peritonitis were the main reasons for PD dropout in both groups. CONCLUSION Compared to the PD first group, a previous HD history may not impact PD dropout rates for patients, but it could impact mortality in the HD to PD group. The reasons for PD dropout differed between the two groups, with no statistical differences. Psychosocial reasons for PD dropout are valuable to further research. Additionally, establishing a consensus on the definition of PD dropout is crucial for future studies.
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Affiliation(s)
- Xingge Sun
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, BT9 7BL, UK
| | - Clare McKeaveney
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, BT9 7BL, UK
| | - Joanne Shields
- Regional Nephrology & Transplant Unit, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, UK
| | - Chi Peng Chan
- Regional Nephrology & Transplant Unit, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, UK
| | - Matthew Henderson
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, Belfast, BT9 7BL, UK
| | - Fiona Fitzell
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, Belfast, BT9 7BL, UK
| | - Helen Noble
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, BT9 7BL, UK
| | - Stephen O'Neill
- Regional Nephrology & Transplant Unit, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, UK.
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, Belfast, BT9 7BL, UK.
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Tian N, Meng H, Fung WWS, Ng JKC, Chan GCK, Kwong VWK, Pang WF, Chow KM, Li PKT, Szeto CC. Peritoneal dialysis after failed kidney allograft: Comparing patients with and without pd before transplant. PLoS One 2023; 18:e0284152. [PMID: 37463181 DOI: 10.1371/journal.pone.0284152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/26/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The result of published studies on the clinical outcome of peritoneal dialysis (PD) after kidney allograft failure is conflicting. There are also few published data on the outcome of patients who had PD before kidney transplant and then return to PD after allograft failure. METHODS We reviewed 100 patients who were started on PD after kidney allograft failure between 2001 and 2020 (failed transplant group); 50 of them received PD before transplant. We compared the clinical outcome to 200 new PD patients matched for age, sex, and diabetic status (control group). RESULTS The patients were followed for 45.8 ± 40.5 months. the 2-year patient survival rate was 83.3% and 87.8% for the failed transplant and control groups, respectively (log rank test, p = 0.2). The corresponding 2-year technique survival rate 66.5% and 71.7% (p = 0.5). The failed transplant and control groups also had similar hospitalization rate and peritonitis rate. In the failed transplant group, there was also no difference in patient survival, technique survival, hospitalization, or peritonitis rate between those with and without PD before transplant. In the failed transplant group, patients who had PD before transplant and then returned to PD after allograft failure had substantial increase in D/P4 (0.585 ± 0.130 to 0.659 ± 0.111, paired t-test, p = 0.032) and MTAC creatinine (7.74 ± 3.68 to 9.73 ± 3.00 ml/min/1.73m2, p = 0.047) from the time before the transplant to the time after PD was resumed after failed allograft. CONCLUSIONS The clinical outcome of PD patients with a failed kidney allograft is similar to other PD patients. However, patients who have a history of PD before kidney transplant and then return to PD after allograft failure have increased peritoneal transport parameters.
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Affiliation(s)
- Na Tian
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia
| | - Han Meng
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia
| | - Winston W S Fung
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Jack K C Ng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Gordon C K Chan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Vickie W K Kwong
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Wing-Fai Pang
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Kai-Ming Chow
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Philip K T Li
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Cheuk Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Meng X, Wu W, Xu S, Cheng Z. Comparison of outcomes of peritoneal dialysis between patients after failed kidney transplant and transplant-naïve patients: a meta-analysis of observational studies. Ren Fail 2021; 43:698-708. [PMID: 33896379 PMCID: PMC8079072 DOI: 10.1080/0886022x.2021.1914659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The influence of prior failed kidney transplants on outcomes of peritoneal dialysis (PD) is unclear. Thus, we conducted a systematic review and meta-analysis to compare the outcomes of patients initiating PD after a failed kidney transplant with those initiating PD without a prior history of kidney transplantation. METHODS We searched PubMed, Embase, CENTRAL, and Google Scholar databases from inception until 25 November 2020. Our meta-analysis considered the absolute number of events of mortality, technical failures, and patients with peritonitis, and we also pooled multi-variable adjusted hazard ratios (HR). RESULTS We included 12 retrospective studies. For absolute number of events, our analysis indicated no statistically significant difference in technique failure [RR, 1.14; 95% CI, 0.80-1.61; I2=52%; p = 0.48], number of patients with peritonitis [RR, 1.13; 95% CI, 0.97-1.32; I2=5%; p = 0.11] and mortality [RR, 1.00; 95% CI, 0.67-1.50; I2=63%; p = 0.99] between the study groups. The pooled analysis of adjusted HRs indicated no statistically significant difference in the risk of technique failure [HR, 1.25; 95% CI, 0.88-1.78; I2=79%; p = 0.22], peritonitis [HR, 1.04; 95% CI, 0.72-1.50; I2=76%; p = 0.85] and mortality [HR, 1.24; 95% CI, 0.77-2.00; I2=66%; p = 0.38] between the study groups. CONCLUSION Patients with kidney transplant failure initiating PD do not have an increased risk of mortality, technique failure, or peritonitis as compared to transplant-naïve patients initiating PD. Further studies are needed to evaluate the impact of prior and ongoing immunosuppression on PD outcomes.
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Affiliation(s)
- Xiaohua Meng
- Department of Nephrology, Huzhou Central Hospital, Affiliated Central Hospital of HuZhou University, Huzhou, Zhejiang Province, P.R. China
| | - Weifei Wu
- Department of Nephrology, Huzhou Central Hospital, Affiliated Central Hospital of HuZhou University, Huzhou, Zhejiang Province, P.R. China
| | - Shuang Xu
- Department of Nephrology, Huzhou Central Hospital, Affiliated Central Hospital of HuZhou University, Huzhou, Zhejiang Province, P.R. China
| | - Zhiqun Cheng
- Department of Nephrology, Huzhou Central Hospital, Affiliated Central Hospital of HuZhou University, Huzhou, Zhejiang Province, P.R. China
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Wang J, Zeng J, Liu B, Cai B, Li Y, Dong L. Outcomes after transfer from hemodialysis to peritoneal dialysis vs peritoneal dialysis as initial therapy: A systematic review and meta-analysis. Semin Dial 2020; 33:299-308. [PMID: 32596853 DOI: 10.1111/sdi.12896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/22/2020] [Indexed: 12/29/2022]
Abstract
Outcomes of patients who are transferred to peritoneal dialysis (PD) after an initial phase of hemodialysis (HD) compared to patients initiating dialysis with PD is controversial. We performed a systematic literature to assess evidence. Primary outcome was overall survival (OS), while secondary outcomes were technique failure, mortality and peritonitis. Meta-analysis indicated that PD initial group had significantly better OS as compared to HD to PD group. Pooled analysis demonstrated a significantly higher probability of technique failure in the HD to PD group as compared to PD initial group. Mortality rate in HD to PD group was significantly higher but there was no statistically significant difference in peritonitis rates between the two groups. On meta-regression analysis, transfer from HD to PD due to vascular access problems was associated with significantly reduced probability of OS. Our study indicates that patients transferred from HD to PD after at least 3 months of HD therapy may have reduced OS as compared to patients initiating dialysis with PD. Our findings lend some support to PD first policy and the need for heightened vigilance among the switched patients to monitor for adverse events.
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Affiliation(s)
- Jin Wang
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, Guangdong, P.R. China
| | - Jianhui Zeng
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, Guangdong, P.R. China
| | - Bin Liu
- Department of Orthopaedics, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, Guangdong, P.R. China
| | - Baolan Cai
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, Guangdong, P.R. China
| | - Yanlin Li
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, Guangdong, P.R. China
| | - Lijuan Dong
- Department of Nursing, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, Guangdong, P.R. China
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Nguyen ANL, Prasad Kafle M, Sud K, Lee VW. Predictors and outcomes of patients switching from maintenance haemodialysis to peritoneal dialysis in Australia and New Zealand: Strengthening the argument for 'peritoneal dialysis first' policy. Nephrology (Carlton) 2018; 24:958-966. [PMID: 30328210 DOI: 10.1111/nep.13512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2018] [Indexed: 11/27/2022]
Abstract
AIMS (1) To determine incidence and reasons for transfer from maintenance haemodialysis (HD) to peritoneal dialysis (PD); (2) To compare mortality of HD patients transferred to PD with those who initiated and remained on PD. METHODS A 1:2 matched cohort of ANZDATA included patients dialyzing over 3 months dividing into 2 groups. Group A (HD to PD) was compared to group B (initiated and remained on PD) and matched PD group (Group C). We compared mortality by total time on dialysis regardless of modality. RESULTS Of 20 882 patients, there were 911 in group A. The transfer rate from HD to PD was 5%, 6.7% and 7.4% at 1,4 and 8 years, respectively. Median time before switching of patients in Group A was 5.9 (4.0-10.9) months. The commonest reported reason for transfer was patient preference (63.8%). Mortality was significantly worse in Group A if dialysis vintage was ≤6 months and from 12-24 months (P < 0.05), whereas there was no difference in mortality if dialysis vintage was 6-12 months or ≥ 24 months (P = 0.073 and P = 0.153, respectively). Overall, mortality of patients in group A was higher than that in group B after adjusting for age, race, chronic lung disease, peripheral vascular disease, cerebrovascular disease, diabetes, haemoglobin and phosphate (hazard ratio = 1.335, 95% confidence interval = 1.172-1.520). CONCLUSION Haemodialysis patients transferred to PD had higher mortality than those initiated on PD, strengthening the case for PD first policy.
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Affiliation(s)
- Anh N L Nguyen
- University of Medicine and Pharmacy Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Nephrology Department, Cho Ray Hospital, Vietnam.,Tribhuvan University, Kathmandu, Nepal
| | - Mukunda Prasad Kafle
- Tribhuvan University, Kathmandu, Nepal.,Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Kamal Sud
- Department of Renal Medicine, Nepean Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | - Vincent W Lee
- Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
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