Carlo Garofalo1, Silvio Borrelli2, Toni De Stefano2, Michele Provenzano3, Michele Andreucci3, Gianfranca Cabiddu4, Vincenzo La Milia5, Valerio Vizzardi6, Massimo Sandrini6, Giovanni Cancarini6, Adamasco Cupisti7, Vincenzo Bellizzi8, Roberto Russo9, Paolo Chiodini10, Roberto Minutolo2, Giuseppe Conte2, Luca De Nicola2. 1. Division of Nephrology, Department of Scienze Mediche e Chirurgiche Avanzate, University of Campania "Luigi Vanvitelli", Via M. Longo 50, 80138, Naples, Italy. carlo.garofalo@hotmail.it. 2. Division of Nephrology, Department of Scienze Mediche e Chirurgiche Avanzate, University of Campania "Luigi Vanvitelli", Via M. Longo 50, 80138, Naples, Italy. 3. Nephrology and Dialysis Division, University Magna Graecia in Catanzaro, Catanzaro, Italy. 4. Nephrology and Dialysis Division, G. Brotzu Hospital, Cagliari, Italy. 5. Nephrology and Dialysis Division, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy. 6. Nephrology and Dialysis Division, ASST Spedali Civili and University of Brescia, Brescia, Italy. 7. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 8. Ruggi d'Aragona Hospital in Salerno, Bari, Italy. 9. Azienda Ospedaliera Universitaria Policlinico, Bari, Italy. 10. Statistic and Epidemiologic Division, University L. Vanvitelli in Naples, Naples, Italy.
Abstract
BACKGROUND: Incremental dialysis may preserve residual renal function and improve survival in comparison with full-dose dialysis; however, available evidence is limited. We therefore compared all-cause mortality and residual kidney function (RKF) loss in incremental and full-dose dialysis and time to full-dose dialysis in incremental hemodialysis (IHD) and incremental peritoneal dialysis (IPD). METHODS: We performed a systematic review and meta-analysis of cohort studies of adults with ESRD starting IHD and IPD. We identified in PubMed and Web of Science database all cohort studies evaluating incremental dialysis evaluating three outcomes: all-cause mortality, RKF loss, time to full dialysis. IPD was defined as < 3 daily dwells in Continuous Ambulatory Peritoneal Dialysis and < 5 sessions per week in Automated Peritoneal Dialysis, while IHD was defined as < 3 HD sessions per week. RESULTS: 22 studies (75,292 participants), 15 in HD and 7 in PD, were analyzed. Mean age at dialysis start was 62 and 57 years in IHD and IPD subjects, respectively. When compared to full dose, incremental dialysis (IHD or IPD) had an overall mortality risk of 1.14 [95% CI 0.85-1.52] with high heterogeneity among studies (I2 86%, P < 0.001), and lower mean RKF loss (- 0.58 ml/min/months, 95% CI 0.16-1.01, P = 0.007). Overall, time to full-dose dialysis was 12.1 months (95% CI 9.8-14.3) with no difference between IHD and IPD (P = 0.217). CONCLUSIONS: Incremental dialysis allows longer preservation of RKF thus deferring full-dose dialysis, by about 1 year in HD and PD, with no increase in mortality risk. Large and adequate studies are needed to confirm these findings.
BACKGROUND: Incremental dialysis may preserve residual renal function and improve survival in comparison with full-dose dialysis; however, available evidence is limited. We therefore compared all-cause mortality and residual kidney function (RKF) loss in incremental and full-dose dialysis and time to full-dose dialysis in incremental hemodialysis (IHD) and incremental peritoneal dialysis (IPD). METHODS: We performed a systematic review and meta-analysis of cohort studies of adults with ESRD starting IHD and IPD. We identified in PubMed and Web of Science database all cohort studies evaluating incremental dialysis evaluating three outcomes: all-cause mortality, RKF loss, time to full dialysis. IPD was defined as < 3 daily dwells in Continuous Ambulatory Peritoneal Dialysis and < 5 sessions per week in Automated Peritoneal Dialysis, while IHD was defined as < 3 HD sessions per week. RESULTS: 22 studies (75,292 participants), 15 in HD and 7 in PD, were analyzed. Mean age at dialysis start was 62 and 57 years in IHD and IPD subjects, respectively. When compared to full dose, incremental dialysis (IHD or IPD) had an overall mortality risk of 1.14 [95% CI 0.85-1.52] with high heterogeneity among studies (I2 86%, P < 0.001), and lower mean RKF loss (- 0.58 ml/min/months, 95% CI 0.16-1.01, P = 0.007). Overall, time to full-dose dialysis was 12.1 months (95% CI 9.8-14.3) with no difference between IHD and IPD (P = 0.217). CONCLUSIONS: Incremental dialysis allows longer preservation of RKF thus deferring full-dose dialysis, by about 1 year in HD and PD, with no increase in mortality risk. Large and adequate studies are needed to confirm these findings.
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Authors: Silvio Borrelli; Michele Provenzano; Ida Gagliardi; Ashour Michael; Maria Elena Liberti; Luca De Nicola; Giuseppe Conte; Carlo Garofalo; Michele Andreucci Journal: Int J Mol Sci Date: 2020-07-03 Impact factor: 5.923