PERITONEAL DIALYSIS IN ACUTE KIDNEY INJURY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction:

Acute kidney injury (AKI) frequently necessitates renal replacement therapy (RRT), with peritoneal dialysis (PD) being an alternative to hemodialysis (HD), hemodiafiltration (HDF), and continuous renal replacement therapy (CRRT). Despite numerous studies, no meta-analysis has comprehensively evaluated differences in mortality or renal recovery between PD and other RRT modalities.

Methods:

We conducted a systematic search of PubMed, Embase, and Cochrane for randomized controlled trials (RCTs) and propensity-matched cohorts (PMC) comparing PD to HD/CRRT/HDF in hospitalized patients with AKI requiring RRT. The primary outcomes included 30-day mortality, kidney function recovery, bleeding, and infection rates. Relative risk (RR) was calculated for binary outcomes, and mean difference (MD) for continuous variables, with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics.

Results:

A total of 6 RCTs and 1 PMC, involving 818 patients (358 on PD, 435 on HD, and 25 on HDF), were included. There were no significant differences in mortality (RR 1.03; 95% CI 0.82–1.29; p=0.815), bleeding (RR 0.44; 95% CI 0.16–1.22; p=0.115), or infection rates (RR 0.71; 95% CI 0.40–1.25; p=0.239) between the groups. However, AKI resolved significantly faster in the PD group (MD -2.52 days; 95% CI -4.58 to -0.45; p=0.017).

Conclusions:

This meta-analysis indicates that PD is associated with a significantly shorter time to renal recovery, with no differences in survival, infection, or bleeding rates compared to other RRT methods. Therefore, PD can be considered a viable alternative to other RRT modalities for AKI management.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.