Dialysis Modality And Mortality In Patients With End Stage Renal Disease: An Update Meta-analysis

Objective:Considerable controversy exists regarding risk of all-cause and cardiovascular mortality between hemodialysis(HD) and peritoneal dialysis(PD) treatment for end stage renal disease(ESRD) patients. We compare the risk of all-cause and cardiovascular mortality in ESRD patients treated with HD and PD.Methods:We Search for articles that compared the risk of all-cause and cardiovascular mortality among ESRD patients treated with HD and PD in Cochrane Library database, PubMed and Embase(1950 to 31 December 2014). Two physicians screened and identified prospective and retrospective cohorts that measured the risk of all-cause and cardiovascular mortality among ESRD patients treated with HD and PD. One reviewer extracted data using a standardized protocol, and another verified data. Both reviewers independently assessed methodological quality of the studies. Statistical analyses were performed utilizing the STATA statistical software(Version 12.0). We calculated pooled odds ratios(OR) and 95% confidence intervals(CI) of the association between dialysis modality and mortality among ESRD patients. To assess the between-study homogeneity more precisely, homogeneity testing among studies was performed by using the I2 statistic to quantify the between-study heterogeneity. According to the I2, heterogeneity was considered mild(<30%), moderate(31-50%) or high(>50%). When there was no evidence of significant heterogeneity, effect sizes were decided using a fixed-effects model, and otherwise we utilized a random effects model. Meta-regression analysis and subgroup analyses was performed to assess sources of heterogeneity. Begg's rank correlation test at P<0.05 were used to assess potential publication bias.Results:We identified 19 studies which fulfilled inclusion criteria. HD and PD had equivalent outcomes in the risk of all-cause mortality by using a random-effects model in prospective cohort studies[odds ratio(OR) 0.80, 95%CI 0.45-1.42; P=0.44] and retrospective cohort studies(OR 0.87, 95%CI 0.73-1.03;P=0.10). The pooled adjusted OR of cardiovascular mortality comparing PD with HD by utilizing a random-effects model was 1.11(95%CI: 0.63-1.94)in prospective cohort studies and 0.65(95%CI:0.40-1.07) in retrospective cohort studies, respectively. The metaregression of retrospective studies shows the duration of observational period explained a significant proportion of the variability in the association between allcause mortality and dialysis modality(P=0.019).Conclusion:Risk for all-cause and cardiovascular mortality does not differ between patients treated with HD and PD, but additional large, high-quality, prospective, randomized controlled trials are needed.