Michał Zawistowski1,2, Joanna Nowaczyk1, Piotr Domagała3. 1. Department of General and Transplantation Surgery, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland. 2. Military Institute of Medicine, Warsaw, Poland. 3. Department of General and Transplantation Surgery, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland. Piotr.Domagala@wum.edu.pl.
Abstract
PURPOSE: An increasing number of patients treated with peritoneal dialysis eventually undergo kidney transplantation. Owing to opposing reports, we aimed to find evidence about the best time for peritoneal dialysis catheter removal in transplant patients. METHODS: We conducted a systematic review and random effects meta-analysis of non-randomized studies of intervention comparing patients with peritoneal dialysis catheters left in place or removed during kidney transplantation in regard to the need for dialysis and occurrence of catheter-related complications. We searched (last update on 8 December 2021) PubMed, Embase, Scopus, and Web of Science for eligible studies. ROBINS-I tool and funnel plot asymmetry analysis were used to assess the quality of included articles. RESULTS: Eight observational studies were evaluated. Five of them, which involved 338 patients, were included in a meta-analysis. All were at moderate to serious risk of bias. The odds of needing dialysis are more than twice as high for patients with peritoneal dialysis catheters left in situ (pooled odds ratio, 2.21; 95% confidence interval [CI], 1.03 to 4.73; I2 = 0%). No statistically significant difference was noted when adult and pediatric subgroups were compared (Q = 0.13, P = .720). More individuals with catheters left in place required dialysis (pooled prevalence, 20.9%; 95% CI, 13.6 to 30.7%; I2 = 59% vs. 12.4%; 95% CI, 5.6 to 25.2%; I2 = 0%) and experienced catheter-related infections. CONCLUSION: Available evidence is scarce. Unless new data from a randomized controlled trial are available, the dilemma of peritoneal dialysis catheter removal cannot be solved. TRIAL REGISTRATION: PROSPERO Protocol ID: CRD42020207707.
PURPOSE: An increasing number of patients treated with peritoneal dialysis eventually undergo kidney transplantation. Owing to opposing reports, we aimed to find evidence about the best time for peritoneal dialysis catheter removal in transplant patients. METHODS: We conducted a systematic review and random effects meta-analysis of non-randomized studies of intervention comparing patients with peritoneal dialysis catheters left in place or removed during kidney transplantation in regard to the need for dialysis and occurrence of catheter-related complications. We searched (last update on 8 December 2021) PubMed, Embase, Scopus, and Web of Science for eligible studies. ROBINS-I tool and funnel plot asymmetry analysis were used to assess the quality of included articles. RESULTS: Eight observational studies were evaluated. Five of them, which involved 338 patients, were included in a meta-analysis. All were at moderate to serious risk of bias. The odds of needing dialysis are more than twice as high for patients with peritoneal dialysis catheters left in situ (pooled odds ratio, 2.21; 95% confidence interval [CI], 1.03 to 4.73; I2 = 0%). No statistically significant difference was noted when adult and pediatric subgroups were compared (Q = 0.13, P = .720). More individuals with catheters left in place required dialysis (pooled prevalence, 20.9%; 95% CI, 13.6 to 30.7%; I2 = 59% vs. 12.4%; 95% CI, 5.6 to 25.2%; I2 = 0%) and experienced catheter-related infections. CONCLUSION: Available evidence is scarce. Unless new data from a randomized controlled trial are available, the dilemma of peritoneal dialysis catheter removal cannot be solved. TRIAL REGISTRATION: PROSPERO Protocol ID: CRD42020207707.
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