Systematic review and meta-analysis: the effect and safety of peritoneal dialysis in patients with end-stage diabetic kidney disease

Abstract

Background: At present, peritoneal dialysis (PD) is widely used in the clinical treatment of patients with end-stage renal disease (ESRD), and comparison of the efficacy of PD and hemodialysis (HD) in the treatment of diabetic kidney disease (DKD) has been reported in a few clinical studies.Methods: In this study, "dialysis", "peritoneal dialysis", "renal replacement therapy", "end-stage renal disease", "diabetic renal disease", and "efficacy and safety" were used as search terms in Chinese and English databases. According to RevMan 5.3 and Stata 13 software provided by the Cochrane Collaboration, a metaanalysis was performed.Results: Four randomized controlled trials were included in this study, and 3 trials described the randomization method, 3 described allocation concealment in detail, and 2 used the blinding method.Compared with the HD treatment in the control group, the PD treatment in the experimental group can significantly reduce the hemoglobin of patients with end-stage DKD [Mean difference (MD) =-0.13, 95% confidence interval (CI): -0.21 to -0.04; P=0.003<0.05] and Albumin level (MD = -0.10, 95% CI: -0.16 to -0.04; P=0.002<0.05). Compared with the control group, the PD treatment in the experimental group significantly increased the serum creatinine and blood urea nitrogen levels in patients with end-stage DKD, but there was no significant difference in the effects of PD and HD treatment on serum creatinine levels (MD =-0.30, 95% CI: -0.77 to 0.16; P=0.20>0.05), (MD =1.93, 95% CI: -2.65 to 6.51; P=-0.41>0.05). In addition, PD treatment in the experimental group significantly increased the probability of malignant tumors in patients with end-stage DKD [odds ratio (OR) =1.86, 95% CI: 1.64 to 2.10; P<0.00001], and the difference was significant.Discussions: This study used meta-analysis to confirm that PD can significantly improve the renal function of patients with end-stage DKD, but it can also increase the probability of protein loss and complications.

Effects and Clinical Value of Peritoneal Dialysis on Water and Water Balance, Adverse Reactions, Quality of Life, and Clinical Prognosis in Patients with Decompensated Chronic Nephropathy: A Systematic Review and Meta-Analysis

“…This is because PD treatment also has some advantages for elderly patients. Some European countries began to implement the strategy of adjuvant PD therapy (including professional nurse-assisted therapy and automated peritoneal dialysis machine therapy), which greatly improved the life quality and survival rate of elderly PD patients [ 44 , 45 ].…”

Mitochondrial metabolic reprogramming in diabetic kidney disease

“…Research indicates that a low-protein diet, when combined with essential amino acids and ketoacids, may decelerate the progression of DKD, provided that intestinal flora balance is maintained, the intestinal barrier is protected, and the production of harmful metabolites and leaky gut are minimized [ 94 ]. However, for patients undergoing dialysis, significant protein loss makes adherence to a low-protein diet challenging [ 95 ]. Current nutritional therapy programs lack clear guidance, and due to individual patient variations, specific nutritional therapy plans cannot be universally recommended.…”

Chinese experience on comparison of clinical efficacy and safety of hemodialysis and peritoneal dialysis in the treatment of diabetic kidney failure: a systematic review and meta-analysis

“…The widespread application of PD in treating patients with diabetic kidney failure has shown promising efficacy and safety. While limited studies which were mostly conducted in Korea and incomprehensive content related to the clinical practice of PD and HD treatment for diabetic kidney failure patients were summarized ( 18 ). This review aims to accomplish a comprehensive evaluation of the clinical efficacy and safety of PD vs. HD in the treatment of diabetic kidney failure patients and serve as a supplemental meta-analysis of studies in this field accomplished outside Korea ( 18 ).…”

“…While limited studies which were mostly conducted in Korea and incomprehensive content related to the clinical practice of PD and HD treatment for diabetic kidney failure patients were summarized ( 18 ). This review aims to accomplish a comprehensive evaluation of the clinical efficacy and safety of PD vs. HD in the treatment of diabetic kidney failure patients and serve as a supplemental meta-analysis of studies in this field accomplished outside Korea ( 18 ). It could contribute to implementing and innovating the treatment method for diabetic kidney failure patients.…”