Altern Ther Health Med. 2022 Sep;28(6):144-149.
End-stage renal disease (ESRD) is the advanced stage of a progressive loss of kidney function. About 10% of all patients with lupus nephritis (LN) eventually progress to ESRD, which may necessitate renal replacement therapy (RRT), such as hemodialysis (HD), peritoneal dialysis (PD), and/or kidney transplant. Research hasn't confirmed which dialysis options, prior to kidney transplantation, are beneficial to patients' prognoses.
The study intended to compare the risks-related to disease activity, exercise, all-cause infection, all-cause cardiovascular events, and mortality-of the use of HD and PD for LN-ESRD adults, as the initial alternative treatment before renal transplantation.
The research team performed a narrative review and analyzed the data obtained about clinical outcomes for HD and peritoneal dialysis. For the review, the research team searched the PubMed, EMBASE, and SCOPUS databases. The search used the keywords: end-stage renal disease, renal replacement therapy, hemodialysis and peritoneal dialysis.
The study made in Affiliated Hospital of Hebei University, China.
The studies included 15 636 patients who had been diagnosed with LN-ESRD prior to renal transplantation.
For the data analysis, the research team divided the data into two groups, one of which included the data on the clinical outcomes for HD patientsand one of which included the data on the clinical outcomes for PD patients. The study evaluated four types of risks: lupus-flare risks, all-cause infection risks, all-cause cardiovascular events risk, and risk of mortality.
The 16 studies found in the review reported one or more outcomes of interest for the two dialysis modalities, HD and PD. The analysis of the data from the 16 studies showed that HD was associated with a higher risk than PD: (1) of lupus flares, with RR = 1.23 (confidence interval: 0.82, 1.85), but the difference didn't reach statistical significance (P = .31); (2) of all-cause infection risk, with RR = 1.02 (confidence interval: 0.66, 1.59), but the difference didn't reach statistical significance (P = .92); (3) of all-cause cardiovascular events, with RR = 1.44 (confidence interval: 1.02, 2.04), and the difference reached statistical significance (P = .04); and (4) of mortality risk, with RR = 1.29 (confidence interval: 0.95, 1.75), but the difference didn't reach statistical significance (P = .10).
The current study may have reference significance for clinical treatment of ESRD. Except for all-cause cardiovascular events in which PD was superior to HD, offering better outcomes, both treatment modalities provide more or less similar clinical outcomes as effective initial choices for RRT in LN-ESRD patients prior to renal transplant. The current research team, however, encourages further research on the question, addressing better the possible sources of biases encountered in the current study.
终末期肾病（ESRD）是肾功能进行性丧失的晚期阶段。大约 10%的狼疮肾炎（LN）患者最终会进展为 ESRD，这可能需要肾脏替代治疗（RRT），如血液透析（HD）、腹膜透析（PD）和/或肾移植。研究尚未确定在肾移植前，哪种透析选择对患者的预后有益。
本研究旨在比较 HD 和 PD 在 LN-ESRD 成人患者中的风险差异，这两种方法都是肾移植前的初始替代治疗方法，比较疾病活动、运动、全因感染、全因心血管事件和死亡率相关的风险。
研究小组进行了叙述性综述，并分析了关于 HD 和腹膜透析的临床结果数据。为了进行综述，研究小组检索了 PubMed、EMBASE 和 SCOPUS 数据库。检索使用的关键词为：终末期肾病、肾脏替代治疗、血液透析和腹膜透析。
中国河北大学附属医院。
该研究纳入了 15636 名在肾移植前被诊断为 LN-ESRD 的患者。
为了数据分析，研究小组将数据分为两组，一组包括 HD 患者的临床结果数据，另一组包括 PD 患者的临床结果数据。研究评估了四种风险：狼疮发作风险、全因感染风险、全因心血管事件风险和死亡率。
综述中发现的 16 项研究报告了两种透析方式（HD 和 PD）的一个或多个感兴趣的结果。对 16 项研究的数据进行分析表明，HD 与 PD 相比具有更高的风险：（1）狼疮发作风险，RR=1.23（置信区间：0.82，1.85），但差异无统计学意义（P=0.31）；（2）全因感染风险，RR=1.02（置信区间：0.66，1.59），但差异无统计学意义（P=0.92）；（3）全因心血管事件风险，RR=1.44（置信区间：1.02，2.04），差异有统计学意义（P=0.04）；（4）死亡率风险，RR=1.29（置信区间：0.95，1.75），但差异无统计学意义（P=0.10）。
本研究可能对 ESRD 的临床治疗具有参考意义。除了 PD 在全因心血管事件方面优于 HD 外，这两种治疗方式在 LN-ESRD 患者肾移植前的 RRT 中作为有效的初始选择提供了或多或少相似的临床结果。然而，当前的研究团队鼓励对这一问题进行进一步的研究，以更好地解决当前研究中遇到的可能存在的偏倚来源。
