Blood Purification

Meta-Analysis

Outcome and Safety of Unplanned-Start Peritoneal Dialysis according to Break-In Periods: A Systematic Review and Meta-Analysis

Yin Y.a · Cao Y.b · Yuan L.b

Author affiliations

aSchool of Nursing, Fudan University, Shanghai, China
bDepartment of Nursing, Huashan Hospital Affiliated to Fudan University, Shanghai, China

Keywords: End-stage kidney diseaseUnplanned-start peritoneal dialysisBreak-in periodsOutcomeMeta-analysis

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Blood Purif 2021;50:161–173
https://doi.org/10.1159/000510550

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Article / Publication Details

First-Page Preview
Abstract of Meta-Analysis

Received: December 22, 2019
Accepted: July 28, 2020
Published online: October 29, 2020
Issue release date: March 2021

Number of Print Pages: 13
Number of Figures: 4
Number of Tables: 2

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

Abstract

Introduction: The best timing of peritoneal dialysis (PD) initiation after catheter implantation is still controversial. It is necessary to explore whether there exists a waiting period to minimize the risk of complications. Methods: A systematic review and meta-analysis were searched in multiple electronic databases published from inception to February 29, 2020, to identify cohort studies for evaluating the outcome and safety of unplanned-start PD (<14 days after catheter insertion). Risks of bias across studies were evaluated using Newcastle-Ottawa Quality Assessment Scale. Results: Fourteen cohort studies with a total of 2,401 patients were enrolled. We found that early-start PD was associated with higher prevalence of leaks (RR: 2.67, 95% CI, 1.55–4.61) and omental wrap (RR: 3.28, 95% CI, 1.14–9.39). Furthermore, patients of unplanned-start PD in APD group have higher risk of leaks, while those in CAPD group have a higher risk of leaks, omental wrap, and catheter malposition. In shorter break-in period (BI) group, the risk of suffering from catheter obstruction and malposition was higher for patients who started dialysis within 7 days after the surgery than for patients within 7–14 days. No significant differences were found in peritonitis (RR: 1.00; 95% CI, 0.78–1.27) and exit-site infections (RR: 1.12; 95% CI, 0.72–1.75). However, shorter BI was associated with higher risk of mortality and transition to hemodialysis (HD) while worsen early technical survival, with pooled RR of 2.14 (95% CI, 1.52–3.02), 1.42 (95% CI, 1.09–1.85) and 0.95 (95% CI, 0.92–0.99), respectively. Conclusions: Evidence suggests that patients receiving unplanned-start PD may have higher risks of mechanical complications, transition to HD, and even mortality rate while worsening early technical survival, which may not be associated with infectious complications. Rigorous studies are required to be performed.

© 2020 S. Karger AG, Basel



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Article / Publication Details

First-Page Preview
Abstract of Meta-Analysis

Received: December 22, 2019
Accepted: July 28, 2020
Published online: October 29, 2020
Issue release date: March 2021

Number of Print Pages: 13
Number of Figures: 4
Number of Tables: 2

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

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2021, Vol.50, No. 2

March 2021

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