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腹膜透析导管在肾移植时或之后的拔除：系统评价和荟萃分析。

Peritoneal dialysis catheter removal at the time or after kidney transplantation: a systematic review and meta-analysis.

机构信息

Department of General and Transplantation Surgery, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland.

Military Institute of Medicine, Warsaw, Poland.

出版信息

Langenbecks Arch Surg. 2022 Nov;407(7):2651-2662. doi: 10.1007/s00423-022-02637-y. Epub 2022 Aug 9.

DOI:10.1007/s00423-022-02637-y
PMID:35945300
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9640428/
Abstract

PURPOSE

An increasing number of patients treated with peritoneal dialysis eventually undergo kidney transplantation. Owing to opposing reports, we aimed to find evidence about the best time for peritoneal dialysis catheter removal in transplant patients.

METHODS

We conducted a systematic review and random effects meta-analysis of non-randomized studies of intervention comparing patients with peritoneal dialysis catheters left in place or removed during kidney transplantation in regard to the need for dialysis and occurrence of catheter-related complications. We searched (last update on 8 December 2021) PubMed, Embase, Scopus, and Web of Science for eligible studies. ROBINS-I tool and funnel plot asymmetry analysis were used to assess the quality of included articles.

RESULTS

Eight observational studies were evaluated. Five of them, which involved 338 patients, were included in a meta-analysis. All were at moderate to serious risk of bias. The odds of needing dialysis are more than twice as high for patients with peritoneal dialysis catheters left in situ (pooled odds ratio, 2.21; 95% confidence interval [CI], 1.03 to 4.73; I = 0%). No statistically significant difference was noted when adult and pediatric subgroups were compared (Q = 0.13, P = .720). More individuals with catheters left in place required dialysis (pooled prevalence, 20.9%; 95% CI, 13.6 to 30.7%; I = 59% vs. 12.4%; 95% CI, 5.6 to 25.2%; I = 0%) and experienced catheter-related infections.

CONCLUSION

Available evidence is scarce. Unless new data from a randomized controlled trial are available, the dilemma of peritoneal dialysis catheter removal cannot be solved.

TRIAL REGISTRATION

PROSPERO Protocol ID: CRD42020207707.

摘要

目的

越来越多接受腹膜透析治疗的患者最终接受了肾移植。由于存在相互矛盾的报告，我们旨在寻找有关移植患者中腹膜透析导管最佳拔除时间的证据。

方法

我们对比较肾移植期间保留或拔除腹膜透析导管的患者在需要透析和发生导管相关并发症方面的干预非随机研究进行了系统评价和随机效应荟萃分析。我们在（最后更新日期为 2021 年 12 月 8 日）PubMed、Embase、Scopus 和 Web of Science 中搜索了合格的研究。使用 ROBINS-I 工具和漏斗图不对称分析来评估纳入文章的质量。

结果

评估了 8 项观察性研究。其中 5 项研究涉及 338 名患者，纳入了荟萃分析。所有研究均存在中度至严重的偏倚风险。与腹膜透析导管保留在位的患者相比，需要透析的患者的几率高出两倍多（汇总优势比，2.21；95%置信区间[CI]，1.03 至 4.73；I  = 0%）。当比较成人和儿科亚组时，未观察到统计学上的显著差异（Q  = 0.13，P  = 0.720）。更多的导管保留在位的患者需要透析（汇总患病率，20.9%；95%CI，13.6 至 30.7%；I  = 59%与 12.4%；95%CI，5.6 至 25.2%；I  = 0%）且发生导管相关感染。

结论

目前的证据有限。除非有新的随机对照试验数据，否则无法解决腹膜透析导管拔除的困境。

试验注册

PROSPERO 方案 ID：CRD42020207707。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d1e/9640428/fa860944e5d0/423_2022_2637_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d1e/9640428/dca66703c485/423_2022_2637_Fig1_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d1e/9640428/834be943e26f/423_2022_2637_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d1e/9640428/fa860944e5d0/423_2022_2637_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d1e/9640428/dca66703c485/423_2022_2637_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d1e/9640428/cb925f2eb549/423_2022_2637_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d1e/9640428/9b35b65f927f/423_2022_2637_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d1e/9640428/583dce40f966/423_2022_2637_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d1e/9640428/834be943e26f/423_2022_2637_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d1e/9640428/fa860944e5d0/423_2022_2637_Fig6_HTML.jpg

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