Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Greece.
College of Medicine and Health, University of Exeter, UK.
Perit Dial Int. 2022 Sep;42(5):470-481. doi: 10.1177/08968608211059888. Epub 2021 Dec 7.
Peritoneal dialysis (PD) represents an important therapeutic option in neonatal acute kidney injury (AKI), although evidence regarding its effects in preterm neonates remains unclear. The present study aims to evaluate the feasibility of PD in very low birthweight (VLBW) and extremely low birthweight (ELBW) infants and clarify the association of catheter choice with clinical outcomes.
Medline, Scopus, Web of Science, Clinicaltrials.gov and CENTRAL databases were systematically searched from inception to 15 January 2021. Studies reporting individual participant data of VLBW and ELBW infants treated with PD were selected.
Overall, 20 studies were included comprising 101 patients. Catheter-related complications were significantly more frequent among ELBW infants (odds ratio: 5.18, 95% confidence intervals (CI): 1.23-29.09). After inverse probability treatment weighting, compared to drainage catheters, death risk was significantly lower with the use of PD (hazard ratio: 0.42, 95% CI: 0.19-0.90) but not vascular catheters (hazard ratio: 0.58, 95% CI: 0.28-1.20). Similarly, kidney function loss was significantly lower only with the implementation of PD catheters (hazard ratio: 0.44, 95% CI: 0.21-0.94).
PD is a feasible kidney replacement therapy modality in VLBW and ELBW infants with AKI. The use of drainage catheters may be linked to significantly worse kidney recovery and overall survival rates, compared to PD catheters. Future cohorts should confirm the most appropriate catheter type and contribute to the standardisation of PD procedures.
腹膜透析（PD）是新生儿急性肾损伤（AKI）的重要治疗选择，尽管在早产儿中的疗效证据仍不明确。本研究旨在评估 PD 在极低出生体重（VLBW）和超低出生体重（ELBW）婴儿中的可行性，并阐明导管选择与临床结局的关系。
系统检索了 Medline、Scopus、Web of Science、Clinicaltrials.gov 和 CENTRAL 数据库，检索时间从建库至 2021 年 1 月 15 日。选择了报道了接受 PD 治疗的 VLBW 和 ELBW 婴儿个体参与者数据的研究。
共有 20 项研究纳入了 101 名患者。ELBW 婴儿的导管相关并发症发生率明显更高（比值比：5.18，95%置信区间（CI）：1.23-29.09）。在进行逆概率处理加权后，与引流导管相比，PD 导管的死亡风险显著降低（风险比：0.42，95%CI：0.19-0.90），但血管导管的死亡风险无显著差异（风险比：0.58，95%CI：0.28-1.20）。同样，只有实施 PD 导管时肾功能丧失率显著降低（风险比：0.44，95%CI：0.21-0.94）。
PD 是 VLBW 和 ELBW 合并 AKI 婴儿的一种可行的肾脏替代治疗方法。与 PD 导管相比，引流导管的使用可能与更差的肾脏恢复和总体生存率相关。未来的队列研究应进一步确认最合适的导管类型，并有助于 PD 操作的标准化。
