Mekraksakit Poemlarp, Suppadungsuk Supawadee, Thongprayoon Charat, Miao Jing, Leelaviwat Natnicha, Thongpiya Jerapas, Qureshi Fawad, Craici Iasmina M, Cheungpasitporn Wisit
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Faculty of Medicine Ramathibodi Hospital, Chakri Naruebodindra Medical Institute, Mahidol University, Samut Prakan, Thailand.
Perit Dial Int. 2025 Mar;45(2):93-105. doi: 10.1177/08968608241237401. Epub 2024 May 17.
Cirrhosis and end-stage kidney disease (ESKD) are significant global health concerns, contributing to high mortality and morbidity. Haemodialysis (HD) is frequently used to treat ESKD in patients with cirrhosis. However, it often presents challenges such as haemodynamic instability during dialysis sessions, leading to less than optimal outcomes. Peritoneal dialysis (PD), while less commonly used in cirrhotic patients, raises concerns about the risks of peritonitis and mortality. Our systematic review and meta-analysis aimed to assess outcomes in PD patients with cirrhosis.
We executed a comprehensive search in Ovid MEDLINE, EMBASE and Cochrane databases up to 25 September 2023. The search focused on identifying studies examining mortality and other clinical outcomes in ESKD patients with cirrhosis receiving PD or HD. In addition, we sought studies comparing PD outcomes in cirrhosis patients to those without cirrhosis. Data from each study were aggregated using a random-effects model and the inverse-variance method.
Our meta-analysis included a total of 13 studies with 15,089 patients. Seven studies compared ESKD patients on PD with liver cirrhosis (2753 patients) against non-cirrhosis patients (9579 patients). The other six studies provided data on PD (824 patients) versus HD (1943 patients) in patients with cirrhosis and ESKD. The analysis revealed no significant difference in mortality between PD and HD in ESKD patients with cirrhosis (pooled odds ratio (OR) of 0.77; 95% confidence interval (CI), 0.53-1.14). In PD patients with cirrhosis, the pooled OR for peritonitis compared to non-cirrhosis patients was 1.10 (95% CI: 1.03-1.18). The pooled ORs for hernia and chronic hypotension in cirrhosis patients compared to non-cirrhosis controls were 2.48 (95% CI: 0.08-73.04) and 17.50 (95% CI: 1.90-161.11), respectively. The pooled OR for transitioning from PD to HD among cirrhotic patients was 1.71 (95% CI: 0.76-3.85). Mortality in cirrhosis patients on PD was comparable to non-cirrhosis controls, with a pooled OR of 1.05 (95% CI: 0.53-2.10).
Our meta-analysis demonstrates that PD provides comparable mortality outcomes to HD in ESKD patients with cirrhosis. In addition, the presence of cirrhosis does not significantly elevate the risk of mortality among patients undergoing PD. While there is a higher incidence of chronic hypotension and a slightly increased risk of peritonitis in cirrhosis patients on PD compared to those without cirrhosis, the risks of hernia and the need to transition from PD to HD are comparable between both groups. These findings suggest PD as a viable and effective treatment option for ESKD patients with cirrhosis.
肝硬化和终末期肾病（ESKD）是全球重大的健康问题，导致高死亡率和高发病率。血液透析（HD）常用于治疗肝硬化患者的ESKD。然而，它常常带来挑战，如透析过程中的血流动力学不稳定，导致治疗效果欠佳。腹膜透析（PD）虽然在肝硬化患者中使用较少，但引发了对腹膜炎风险和死亡率的担忧。我们的系统评价和荟萃分析旨在评估肝硬化患者接受PD治疗的结局。
我们在截至2023年9月25日的Ovid MEDLINE、EMBASE和Cochrane数据库中进行了全面检索。检索重点是识别研究接受PD或HD治疗的肝硬化ESKD患者的死亡率和其他临床结局的研究。此外，我们还查找了比较肝硬化患者与非肝硬化患者PD结局的研究。使用随机效应模型和逆方差法汇总每项研究的数据。
我们的荟萃分析共纳入13项研究，涉及15,089例患者。7项研究比较了接受PD治疗的肝硬化ESKD患者（2753例）与非肝硬化患者（9579例）。其他6项研究提供了肝硬化和ESKD患者中PD（824例）与HD（1943例）的数据。分析显示，肝硬化ESKD患者中PD和HD的死亡率无显著差异（合并比值比（OR）为0.77；95%置信区间（CI），0.53 - 1.14）。在肝硬化PD患者中，与非肝硬化患者相比，腹膜炎的合并OR为1.10（95% CI：1.03 - 1.18）。与非肝硬化对照组相比，肝硬化患者疝气和慢性低血压的合并OR分别为2.48（95% CI：0.08 - 73.04）和17.50（95% CI：1.90 - 161.11）。肝硬化患者从PD转为HD的合并OR为1.71（95% CI：0.76 - 3.85）。肝硬化患者接受PD治疗的死亡率与非肝硬化对照组相当，合并OR为1.05（95% CI：0.53 - 2.10）。
我们的荟萃分析表明，在肝硬化ESKD患者中，PD与HD的死亡率相当。此外，肝硬化的存在并未显著增加接受PD治疗患者的死亡风险。虽然与非肝硬化患者相比，肝硬化患者接受PD治疗时慢性低血压的发生率较高，腹膜炎风险略有增加，但两组疝气风险和从PD转为HD的需求相当。这些发现表明PD是肝硬化ESKD患者可行且有效的治疗选择。
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