Outcomes Of Patients With Polycystic Kidney Disease On Peritoneal Dialysis:A Meta-Analysis

Objective/Aim:Polycystic kidney disease(PKD)is the commonest hereditary kidney disease that causes renal failure.As renal replacement therapy is needed when renal failure progresses to the end stage and the enlarged kidneys of polycystic kidney patients may generate lower area of effective peritoneal dialysis(PD),the effect of peritoneal dialysis is influenced,from which higher infra-abdominal pressure may be resulted.Thus,there may be higher risk of several peritoneal dialysis(PD)related complications such as ventral hernia and peritonitis,which may eventually lead to increased mortality of the patients.Hence whether patients with polycystic kidney disease(PKD)at end stage can choose peritoneal dialysis or not has been controversial.Therefore,this paper intends to search relevant literature for meta-analysis to compare the efficacy and safety of peritoneal dialysis(PD)for patients with end-stage polycystic kidney disease(PKD)and those with end-stage non-polycystic kidney disease(non-PKD).Methods:We retrieved PubMed,Cochrane Library database,MEDLINE,EMBASE,CNKI,Wanfang Database,from which public published both Chinese and English literatures on cohort studies which comparing the effect of peritoneal dialysis of patients with PKD and non-PKD before December 2018 were collected.Two researchers screened and confirmed the literatures according to the inclusion criteria and exclusion criteria with references as a supplement.They separately extracted relevance data,evaluated the quality of literature,and applied Revman 5.3 software for data consolidation analysis.Begg's test and Egger's test were used to analyze publication bias.The metanif command was used to analyze the results of the statistical data.Results:We ultimately included 12 studies that conformed to the inclusion criteria,including a total of 4274 patients(721 in the polycystic kidney group and 3553 in thenon-polycystic kidney group).No significant difference was observed on dialysis adequacy(Kt/V,WMD:-0.04,95% CI:-0.20–0.13),peritonitis(RR: 0.97,95% CI0.89~1.09),technique survival rate(RR: 1.0,95% CI: 0.94-1.06),conversion to hemodialysis(RR: 0.99,95% CI: 0.80-1.07),compared with non-PKD subjects undergoing PD,the proportion of all-cause mortality in PKD patients was lower than that of non-PKD patients(RR: 0.73,95% CI: 1.10 – 1.53).However,the proportion of abdominal hernia(RR: 3.65,95% CI: 2.15 – 6.17)and renal transplantation(RR: 1.30,95%CI: 1.10–1.53)in PKD patients was higher than that of non-PKD patients.Conclusion:This meta-analysis research results suggest: there was no significant difference of the therapeutic efficacy and safety between the end-stage PKD patients and the end-stage non-PKD patients;Even the all-cause mortality rate of the end-stage PKD patients is lower than that of the end-stage non-PKD patients.Therefore,PD can also be a suitable option for the end-stage PKD patients.However,due to the insufficiency of follow-up time in studies and sample size,more rigorous and multi-center high-quality studies are still needed to provide evidence-based medical evidence to support the efficacy and safety of peritoneal dialysis for the end-stage renal disease(ESRD)patients with PKD.