The Long-term Clinical Outcomes In Patients On Automated Peritoneal Dialysis Versus Continuous Ambulatory Peritoneal Dialysis

Objectives:Previous meta-analysis has shown similar all-cause mortality and technique failure rates in patients on automated peritoneal dialysis and continuous ambulatory peritoneal dialysis.However,recent update studies indicated that the outcomes of APD compared with CAPD in patient and technique survival remains controversial.Therefore,this study systematically reviewed all relevant new studies,and conducted an update meta-analysis to explore whether peritoneal dialysis modality has an impact on all-cause mortality and technique failure in patients with end-stage renal disease.Methods:All relevant studies comparing the risk of all-cause mortality and technique failure between APD and CAPD in Pub Med,Embase,the Cochrane Central Register of Controlled Trials,China national knowledge infrastructure,Weipu and Wanfang databases were systematically searched from database inception to 1 April 2021.The adjusted hazard ratios with 95%confidence intervals were selected to pool estimates and the Newcastle-Ottawa Scale was used to assess the quality of the included studies.Heterogeneity was tested using Q test and I~2test.Sensitivity analysis was conducted to investigate the influence of each included study on the pooled estimates and the stability of the results.Begg’s test and Egger’s test were used to verify publication bias.Results:A total of 17 studies involving more than 230,000 PD patients were included in this update meta-analysis,and showing that patients on APD and CAPD had similar risk of technical failure[HR 0.91(95%CI,0.81～1.02);P=0.121].However,compared with CAPD,APD can significantly reduce the risk of all-cause mortality of PD patients[HR 0.87(95%CI,0.77～0.99);P=0.038].In addition,the as-treated(AT)subgroup[HR 0.75(95%CI,0.63～0.90);P=0.002],the Asia subgroup[HR 0.76(95%CI,0.67～0.86);P<0.001],the Europe subgroup[HR 0.81(95%CI,0.74～0.89);P<0.001]and the subgroup of studies published after 2012[HR 0.82(95%CI,0.68～0.99);P=0.035]also showed that patients treated with APD had better patient survival than those treated with CAPD.However,in the intent-to-treat analysis(ITT)subgroup[HR 0.89(95%CI,0.78～1.03);P=0.112],the America subgroup[HR 0.94(95%CI,0.78～1.13);P=0.481]and the subgroup of studies published before 2012[HR 1.03(95%CI,0.99～1.06);P=0.099],APD was as effective as CAPD in terms of patient survival.Conclusions:Compared with CAPD,APD can significantly reduce the risk of all-cause mortality in PD patients,especially in the AT subgroup,the Asia subgroup,the Europe subgroup and in the subgroup of studies published after 2012.However,there was no statistically significant difference in the risk of technical failure between APD and CAPD.