Combination Of Peritoneal Dialysis And Hemodialysis As A Modality Of Treatment For End-stage Renal Disease:A Systematic Review And Meta-analysis

Objective Peritoneal dialysis(PD)and hemodialysis are recommended as two first-line renal replacement therapy(RRT)for end-stage renal disease(ESRD)patients.Both have advantages and disadvantages.Therefore,we hypothesized that a combined therapy with PD and HD might improve clinical status and improve the quality of life who undergoing dialysis.The objective of the present study was to evaluate whether the combined therapy is useful for the end-stage renal disease patients.Methods We Searched through the database Pub Med,Embase,Cochrane Library database,wanfang and CNKI including articles published from 1950 to 31 December2016.We searched articles about the combination therapy with peritoneal dialysis and hemodialysis in patients with end-stage renal disease.Two physicians screened and identified the articles,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 Revman statistical software(Versio 5.3).We calculated pooled odds ratios(OR),weighted mean difference(WMD)and 95% confidence intervals(CI)of the association between both therapies 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.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 17 studies which fulfilled inclusion criteria,including 9randomized controlled trials and 8 non randomized controlled trials.A total of 1424 patients were included,they divided into two groups,one is control group,theperitoneal dialysis group,702 cases.Meanwhile,the experimental group,the combination therapy with peritoneal dialysis and hemodialysis group,722 cases.The results of Meta analysis showed that compared with the control group,the level of serum creatinineand urea nitrogen in the experimental group were lower(P<0.05),hemoglobin and serum albumin were higher(P<0.05),the incidence of complications was lower(P<0.05).Conclusion The combined therapy with peritoneal dialysis and hemodialysis provides such accompanying beneficial effects.Such as sufficient removal of small molecule solutes,improvement of quality of life.Furthermore,it is associated with the decreased morbidity of hypoproteinemia,peritoneal infection,cardiovascular disease.But additional large,high-quality,prospective,randomized controlled trials are needed.