Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, USA.
Department of Internal Medicine, Bassett Medical Centre, Cooperstown, New York, USA.
Nephrology (Carlton). 2019 Jun;24(6):638-646. doi: 10.1111/nep.13431. Epub 2019 Apr 23.
Complications related to peritoneal dialysis (PD) in patients with autosomal-dominant polycystic kidney disease (ADPKD), including intraperitoneal rupture of renal cyst, hernia, membrane failure and peritonitis, have been reported. However, long-term clinical outcomes of ADPKD patients on PD remain unclear. We performed this meta-analysis to assess the risks of death, technique failure and peritonitis in ADPKD patients on PD.
A systematic review was conducted using MEDLINE, EMBASE and Cochrane databases from inception to October 2017 to identify studies that evaluated the outcomes of ADPKD patients on PD, including the risks of death, technique failure and peritonitis. Non-ADPKD patients on PD were used as controls. Effect estimates from the individual study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird.
Twelve cohort studies with a total of 14 673 patients on PD (931 ADPKD and 13 742 non-ADPKD patients) were enrolled. Compared with non-ADPKD status, ADPKD was associated with significantly decreased mortality risk with pooled odds ratio (OR) of 0.68 (95% confidence interval (CI), 0.53-0.86; I = 0). There were no associations of ADPKD with the risks of technique failure of PD and peritonitis with pooled OR of 0.93 (95% CI, 0.79-1.10; I = 0) and 0.88 (95% CI, 0.75-1.05; I = 0), respectively. We found no publication bias as assessed by Egger's regression asymmetry test, with P = 0.90, 0.28 and 0.60 for the risks of mortality, technique failure and peritonitis in ADPKD patients on PD, respectively.
Compared with non-ADPKD patients on PD, our study demonstrates that ADPKD patients on PD have 0.68-fold decreased mortality risk. There are no associations of ADPKD status with the risks of technique failure or peritonitis.
常报道多囊肾病（ADPKD）患者行腹膜透析（PD）时的相关并发症，包括肾囊肿破裂、疝、膜衰竭和腹膜炎。然而，ADPKD 患者 PD 的长期临床结局尚不清楚。我们进行了此项荟萃分析，以评估 ADPKD 患者 PD 的死亡、技术失败和腹膜炎风险。
从建库到 2017 年 10 月，通过 MEDLINE、EMBASE 和 Cochrane 数据库进行系统评价，以确定评估 ADPKD 患者 PD 结局的研究，包括死亡、技术失败和腹膜炎风险。PD 非 ADPKD 患者作为对照。从个体研究中提取效应估计值，采用 DerSimonian 和 Laird 的随机效应、通用逆方差方法进行合并。
纳入了 12 项队列研究，共纳入 14673 例 PD 患者（931 例 ADPKD 和 13742 例非 ADPKD 患者）。与非 ADPKD 状态相比，ADPKD 患者的死亡率显著降低，合并比值比（OR）为 0.68（95%置信区间（CI），0.53-0.86；I²=0）。ADPKD 与 PD 技术失败和腹膜炎风险无关，合并 OR 分别为 0.93（95%CI，0.79-1.10；I²=0）和 0.88（95%CI，0.75-1.05；I²=0）。Egger 回归不对称检验表明，我们未发现发表偏倚，ADPKD 患者 PD 的死亡率、技术失败和腹膜炎风险的 P 值分别为 0.90、0.28 和 0.60。
与 PD 非 ADPKD 患者相比，我们的研究表明，ADPKD 患者 PD 的死亡率降低了 0.68 倍。ADPKD 状态与技术失败或腹膜炎风险无关。
