Key result
Initial PD cuts mortality ~52% versus switching from HD with no difference in dropout rates.
Why the study?
Patient experiences and survival outcomes can be influenced by dialysis initiation circumstances and modality choices, but the rate and reasons for PD dropout following a switch from HD to PD were not well explored.
Does starting with peritoneal dialysis (PD first) compared to switching from haemodialysis to PD affect PD dropout rates and mortality?
Meta-Analysis
Does starting with peritoneal dialysis (PD first) compared to switching from haemodialysis to PD affect PD dropout rates and mortality?
A previous history of haemodialysis before switching to peritoneal dialysis is associated with higher mortality compared to starting with peritoneal dialysis first, though PD dropout rates may not differ.
HD-to-PD switch shows comparable dropout risk to PD-first; leaves open optimal initial modality sequencing pending prospective trials.
BACKGROUND: Patient experiences and survival outcomes can be influenced by the circumstances related to dialysis initiation and subsequent modality choices. This systematic review and meta-analysis aimed to explore the rate and reasons for peritoneal dialysis (PD) dropout following haemodialysis (HD) to PD switch. METHOD: This systematic review conducted searches in four databases, including Medline, PubMed, Embase, and Cochrane. The protocol was registered on PROSPERO (study ID: CRD42023405718). Outcomes included factors leading to the switch from HD to PD, the rate and reasons for PD dropout and mortality difference in two groups (PD first group versus HD to PD group). The Critical Appraisal Skills Programme (CASP) checklist and the GRADE tool were used to assess quality. RESULTS: = 83%; P = 0.16), however, there was a statistically significant reduction in the rate of mortality (OR: 0.48; 95%CI: 0.25, 0.92; I2 = 73%; P = 0.03) compared to the HD to PD group. The primary reasons for HD to PD switch, included vascular access failure, patient preference, social issues, and cardiovascular disease. Causes for PD dropout differed between the two groups, but inadequate dialysis and peritonitis were the main reasons for PD dropout in both groups. CONCLUSION: Compared to the PD first group, a previous HD history may not impact PD dropout rates for patients, but it could impact mortality in the HD to PD group. The reasons for PD dropout differed between the two groups, with no statistical differences. Psychosocial reasons for PD dropout are valuable to further research. Additionally, establishing a consensus on the definition of PD dropout is crucial for future studies.
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Sun et al. (2024) conducted a meta-analysis in End-stage kidney disease (ESKD). Peritoneal dialysis as initial therapy (PD first) vs. Switch from hemodialysis to peritoneal dialysis (HD to PD) was evaluated on Peritoneal dialysis dropout (OR 0.81, 95% CI 0.61, 1.09, p=0.16). Starting peritoneal dialysis as initial therapy showed no significant difference in peritoneal dialysis dropout (OR 0.81) but significantly reduced mortality (OR 0.48) compared to switching from hemodialysis to peritoneal dialysis.
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