Peritoneal dialysis for acute kidney injury

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

doi:10.1002/14651858.CD011457.pub2

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Figure 1

Flow chart of the article selection process

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Figure 2

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

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Figure 3

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

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Analysis 1.1

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

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Analysis 1.2

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

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Analysis 1.3

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

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Analysis 1.4

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

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Analysis 1.5

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

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Analysis 1.6

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

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Analysis 1.7

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

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Analysis 2.1

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

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Analysis 2.2

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

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Analysis 2.3

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

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Analysis 2.4

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

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Analysis 2.5

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

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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 low^1,2,3	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 low^1,2,3	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)	⊕⊕⊝⊝ Low^1,2	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 low^1,2,3	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)	⊕⊕⊝⊝ Low^1,3	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

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

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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]

Comparison 1. Peritoneal dialysis versus extracorporeal therapy

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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

Comparison 2. High versus low intensity peritoneal dialysis

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