Outcomes after transfer from hemodialysis to peritoneal dialysis vs peritoneal dialysis as initial therapy: A systematic review and meta-analysis.

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.