Systematic review and meta-analysis of clinical outcomes comparison between different initial dialysis modalities in end-stage renal disease patients due to lupus nephritis prior to renal transplantation

Joel Swai, Xiexiong Zhao, Julie-Raisa Noube, Gui Ming, Joel Swai, Xiexiong Zhao, Julie-Raisa Noube, Gui Ming

Abstract

Background: Regarding lupus disease activity, morbidity and survival, limited literature concluded conflicting results when comparing hemodialysis versus peritoneal dialysis as initial renal replacement therapies (RRT) prior to transplantation, in lupus nephritis end-stage renal disease (LN-ESRD) patients. This study was aimed to compare the risks of lupus flares, all-cause infections, all-cause cardiovascular events, and mortality, between hemodialysis versus peritoneal dialysis as initial RRT - modality before renal-transplant in LN-ESRD patients, by systematic review and meta-analysis.

Methods: PubMed, EMBASE, and SCOPUS were searched for observational-studies comparing LN-ESRD -patients undergoing hemodialysis (Group1) versus peritoneal-dialysis (Group 2) prior to renal-transplantation, by their risks of lupus flare, all-cause infections, all-cause cardiovascular events, and mortality as outcome measures. Relative-Risks of outcomes between the groups measured overall effects at a 95% significance level. RevMan 5.3 computer software was used for analysis.

Results: From search, 16 eligible studies reported 15,636 LN-ESRD -patients prior to renal transplantation with 4616 patients on hemodialysis, 2089 on peritoneal dialysis, 280 directly underwent kidney transplantation, 8319 were eliminated with reasons and 332 participants' details were not reported. Hemodialysis group had higher risk of all-cause cardiovascular events, Relative-Risk = 1.44 (Confidence Interval:1.02, 2.04), p-Value< 0.05. With regards to risks for mortality, flare and all-cause infections, there were trends that were not statistically significant (p-Value> 0.05).

Conclusion: Except for all-cause cardiovascular events in which peritoneal dialysis is superior to hemodialysis offering better outcomes, both treatment modalities offer more or less similar clinical outcomes as effective initial choices of RRT in LN-ESRD patients prior to renal transplant.

The protocol registration: PROSPERO 2019 CRD42019131600.

Keywords: Kidney failure, chronic; Lupus nephritis; Meta-analysis; Renal Dialysis.

Conflict of interest statement

Authors declared no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA 2009 Flow Diagram for study selection
Fig. 2
Fig. 2
Risk of lupus flares in LN-ESRD undergoing hemodialysis and those undergoing peritoneal dialysis
Fig. 3
Fig. 3
All-cause cardiovascular events in LN-ESRD undergoing hemodialysis and peritoneal dialysis
Fig. 4
Fig. 4
All-cause infection risk in LN-ESRD undergoing hemodialysis and peritoneal dialysis
Fig. 5
Fig. 5
Risk of mortality of LN-ESRD patients undergoing hemodialysis and those undergoing peritoneal dialysis

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