Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, Guangdong, P.R. China.
Department of Orthopaedics, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, Guangdong, P.R. China.
Semin Dial. 2020 Jul;33(4):299-308. doi: 10.1111/sdi.12896. Epub 2020 Jun 29.
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.
将初始阶段接受血液透析（HD）治疗的患者转为腹膜透析（PD）与直接开始 PD 治疗的患者相比，其转归尚存在争议。我们进行了系统的文献检索以评估相关证据。主要结局为总生存（OS），次要结局为技术失败、死亡率和腹膜炎。Meta 分析表明，与 HD 转 PD 组相比，PD 初始组的 OS 明显更好。汇总分析显示，HD 转 PD 组的技术失败概率显著高于 PD 初始组。HD 转 PD 组的死亡率显著更高，但两组的腹膜炎发生率无统计学差异。Meta 回归分析显示，因血管通路问题从 HD 转 PD 与 OS 显著降低相关。我们的研究表明，与直接开始 PD 治疗的患者相比，至少经过 3 个月 HD 治疗后转为 PD 的患者 OS 可能降低。我们的研究结果为 PD 优先策略提供了一定支持，并需要对转为 PD 的患者进行更密切的监测，以观察不良事件。
