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Cochrane Database of Systematic Reviews

Peritoneal dialysis for acute kidney injury

Information

DOI:
https://doi.org/10.1002/14651858.CD011457.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 04 December 2017see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Kidney and Transplant Group

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Linfeng Liu

    Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China

  • Ling Zhang

    Correspondence to: Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China

    [email protected]

    [email protected]

  • Guan J Liu

    Cochrane China, West China Hospital, Sichuan University, Chengdu, China

  • Ping Fu

    Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China

Contributions of authors

  1. Draft the protocol: Linfeng Liu, Ling Zhang, Guan J Liu, Ping Fu

  2. Study selection: Linfeng Liu, Ling Zhang

  3. Extract data from studies: Linfeng Liu, Ling Zhang

  4. Enter data into RevMan: Linfeng Liu, Ling Zhang

  5. Carry out the analysis: Linfeng Liu, Ling Zhang, Ping Fu

  6. Interpret the analysis: Linfeng Liu, Ling Zhang, Guan J Liu

  7. Draft the final review: Linfeng Liu, Ling Zhang, Ping Fu

  8. Disagreement resolution: Ping Fu, Guan J Liu

  9. Update the review: Linfeng Liu, Ling Zhang

Declarations of interest

  • Linfeng Liu: none known

  • Ling Zhang: none known

  • Guan J Liu: none known

  • Ping Fu: none known.

Acknowledgements

The authors would like to thank the referees and Cochrane Kidney and Transplant's editorial team for their comments and feedback during the preparation of this review.

Version history

Published

Title

Stage

Authors

Version

2017 Dec 04

Peritoneal dialysis for acute kidney injury

Review

Linfeng Liu, Ling Zhang, Guan J Liu, Ping Fu

https://doi.org/10.1002/14651858.CD011457.pub2

2015 Feb 19

Peritoneal dialysis for acute kidney injury

Protocol

Linfeng Liu, Ling Zhang, Guan J Liu, Ping Fu

https://doi.org/10.1002/14651858.CD011457

Differences between protocol and review

The problem of length of in‐hospital stays or ICU stays, blood pressure during dialysis, and vasopressor support which might influence outcomes in AKI were not reported in most of the four included studies, leading to the lack of further analysis according to design in advance. In addition, the limited studies and patients make it difficult to conduct further subgroup analysis.

Notes

The authors declare that they have no relevant financial interests.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Flow chart of the article selection process
Figures and Tables -
Figure 1

Flow chart of the article selection process

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 1 All‐cause mortality.
Figures and Tables -
Analysis 1.1

Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 1 All‐cause mortality.

Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 2 Recovery of kidney function.
Figures and Tables -
Analysis 1.2

Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 2 Recovery of kidney function.

Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 3 Weekly delivered Kt/V.
Figures and Tables -
Analysis 1.3

Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 3 Weekly delivered Kt/V.

Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 4 Correction of acidosis.
Figures and Tables -
Analysis 1.4

Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 4 Correction of acidosis.

Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 5 Fluid removal.
Figures and Tables -
Analysis 1.5

Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 5 Fluid removal.

Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 6 Duration of dialysis.
Figures and Tables -
Analysis 1.6

Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 6 Duration of dialysis.

Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 7 Infectious complications (catheter infection or peritonitis).
Figures and Tables -
Analysis 1.7

Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 7 Infectious complications (catheter infection or peritonitis).

Comparison 2 High versus low intensity peritoneal dialysis, Outcome 1 All‐cause mortality.
Figures and Tables -
Analysis 2.1

Comparison 2 High versus low intensity peritoneal dialysis, Outcome 1 All‐cause mortality.

Comparison 2 High versus low intensity peritoneal dialysis, Outcome 2 Recovery of kidney function.
Figures and Tables -
Analysis 2.2

Comparison 2 High versus low intensity peritoneal dialysis, Outcome 2 Recovery of kidney function.

Comparison 2 High versus low intensity peritoneal dialysis, Outcome 3 Weekly delivered Kt/V.
Figures and Tables -
Analysis 2.3

Comparison 2 High versus low intensity peritoneal dialysis, Outcome 3 Weekly delivered Kt/V.

Comparison 2 High versus low intensity peritoneal dialysis, Outcome 4 Fluid removal.
Figures and Tables -
Analysis 2.4

Comparison 2 High versus low intensity peritoneal dialysis, Outcome 4 Fluid removal.

Comparison 2 High versus low intensity peritoneal dialysis, Outcome 5 Infectious complications (catheter infection or peritonitis).
Figures and Tables -
Analysis 2.5

Comparison 2 High versus low intensity peritoneal dialysis, Outcome 5 Infectious complications (catheter infection or peritonitis).

Summary of findings for the main comparison. Peritoneal dialysis compared with haemodialysis for acute kidney injury

Peritoneal dialysis versus extracorporeal therapy for acute kidney injury

Patient or population: patients with acute kidney injury

Settings: inpatient

Intervention: peritoneal dialysis

Comparison: extracorporeal therapy

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Extracorporeal therapy

Peritoneal dialysis

All‐cause mortality

542 per 1000

607 per 1000

(439 to 841)

RR 1.12 (0.81 to 1.55)

4 (383)

⊕⊕⊕⊝
Moderate1

Downgraded for study limitations

Recovery of kidney function

284 per 1000

270 per 1000

(193 to 384)

RR 1.42 (0.74 to 2.75)

3 (333)

⊕⊕⊕⊝
Moderate1

Downgraded for study limitations

Weekly delivered Kt/V

The mean delivered Kt/V was 2.47 lower (5.17 lower to 0.22 higher) in the peritoneal dialysis group compared to the extracorporeal therapy group

2 (263)

⊕⊝⊝⊝
Very low1,2,3

Downgraded for study limitations, imprecision and insufficient data

Correction of acidosis

577 per 1000

762 per 1000

(70 to 1,000)

RR 1.32 (0.1 to 13.60)

2 (120)

⊕⊝⊝⊝
Very low1,2,3

Downgraded for study limitations, imprecision and insufficient data

Fluid removal (L/d)

The mean fluid removal was 0.59 L/d lower (1.19 lower to 0.01 higher) in the peritoneal dialysis group compared to the extracorporeal therapy group

3 (313)

⊕⊕⊝⊝
Low1,2

Downgraded for study limitations and imprecision

Duration of dialysis (hours)

The mean duration of dialysis was 1.01 hours less (91.49 lower to 92.54 higher) in the peritoneal dialysis group compared to the extracorporeal therapy group

2 (170)

⊕⊝⊝⊝
Very low1,2,3

Downgraded for study limitations, imprecision and insufficient data

Infectious complications

169 per 1000

174 per 1000

(101 to 301)

RR 1.03 (0.60 to 1.78)

2 (263)

⊕⊕⊝⊝
Low1,3

Downgraded for study limitations and insufficient data

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Three studies did not report details about random sequence generation or allocation concealment or both

2Small numbers with wide CI

3Few studies (no more than 2) reported the relevant data

Figures and Tables -
Summary of findings for the main comparison. Peritoneal dialysis compared with haemodialysis for acute kidney injury
Comparison 1. Peritoneal dialysis versus extracorporeal therapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All‐cause mortality Show forest plot

4

383

Risk Ratio (M‐H, Random, 95% CI)

1.12 [0.81, 1.55]

2 Recovery of kidney function Show forest plot

3

333

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.68, 1.35]

3 Weekly delivered Kt/V Show forest plot

2

263

Mean Difference (IV, Random, 95% CI)

‐2.47 [‐5.17, 0.22]

4 Correction of acidosis Show forest plot

2

89

Risk Ratio (M‐H, Random, 95% CI)

1.32 [0.13, 13.60]

5 Fluid removal Show forest plot

3

313

Mean Difference (IV, Random, 95% CI)

‐0.59 [‐1.19, 0.01]

6 Duration of dialysis Show forest plot

2

170

Mean Difference (IV, Random, 95% CI)

‐1.01 [‐91.49, 89.47]

7 Infectious complications (catheter infection or peritonitis) Show forest plot

2

263

Risk Ratio (M‐H, Random, 95% CI)

1.03 [0.60, 1.78]

Figures and Tables -
Comparison 1. Peritoneal dialysis versus extracorporeal therapy
Comparison 2. High versus low intensity peritoneal dialysis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All‐cause mortality Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Recovery of kidney function Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Weekly delivered Kt/V Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

4 Fluid removal Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

5 Infectious complications (catheter infection or peritonitis) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figures and Tables -
Comparison 2. High versus low intensity peritoneal dialysis