Advanced search
1 file | 208.19 KB

Dialysis modality choice in diabetic patients with end-stage kidney disease: a systematic review of the available evidence

Author
Organization
Abstract
BACKGROUND: Diabetes is the leading cause of end-stage kidney disease (ESKD). Because of conflicting results in observational studies, it is still subject to debate whether in diabetic patients the dialysis modality selected as first treatment (haemodialysis or peritoneal dialysis) may have a major impact on outcomes. We therefore aimed at performing a systematic review of the available evidence. METHODS: MEDLINE, EMBASE and CENTRAL databases were searched until February 2014 for English-language articles without time or methodology restrictions by highly sensitive search strategies focused on diabetes, end-stage kidney disease and dialysis modality. Selection of relevant studies, data extraction and analysis were performed by two independent reviewers. RESULTS: Twenty-five observational studies (23 on incident and 2 on prevalent cohorts) were included in this review. Mortality was the only main outcome addressed in large cohorts. When considering patient survival, results were inconsistent and varied across study designs, follow-up period and subgroups. We therefore found no evidence-based arguments in favour or against a particular dialysis modality as first choice treatment in patients with diabetes and ESKD. However, peritoneal dialysis (PD) as first choice seems to convey a higher risk of death in elderly and frail patients. CONCLUSIONS: The available evidence derived from observational studies is inconsistent. Therefore evidence-based arguments indicating that HD or PD as first treatment may improve patient-centred outcomes in diabetics with ESKD are lacking. In the absence of such evidence, modality selection should be governed by patient preference, after unbiased patient information.
Keywords
systematic review, peritoneal dialysis, haemodialysis, epidemiology, diabetes, NATIONAL COHORT, INCIDENT HEMODIALYSIS, ESRD PATIENTS, PERITONEAL-DIALYSIS, COMPETING RISKS, ADJUSTED MORTALITY-RATES, RENAL REPLACEMENT THERAPY, QUALITY-OF-LIFE, UNITED-STATES, COMPARING MORTALITY

Downloads

  • (...).pdf
    • full text
    • |
    • UGent only
    • |
    • PDF
    • |
    • 208.19 KB

Citation

Please use this url to cite or link to this publication:

Chicago
Couchoud, Cécile, Davide Bolignano, Ionut Nistor, Kitty J Jager, James Heaf, Olle Heimburger, and Wim Van Biesen. 2015. “Dialysis Modality Choice in Diabetic Patients with End-stage Kidney Disease: a Systematic Review of the Available Evidence.” Nephrology Dialysis Transplantation 30 (2): 310–320.
APA
Couchoud, C., Bolignano, D., Nistor, I., Jager, K. J., Heaf, J., Heimburger, O., & Van Biesen, W. (2015). Dialysis modality choice in diabetic patients with end-stage kidney disease: a systematic review of the available evidence. NEPHROLOGY DIALYSIS TRANSPLANTATION, 30(2), 310–320.
Vancouver
1.
Couchoud C, Bolignano D, Nistor I, Jager KJ, Heaf J, Heimburger O, et al. Dialysis modality choice in diabetic patients with end-stage kidney disease: a systematic review of the available evidence. NEPHROLOGY DIALYSIS TRANSPLANTATION. 2015;30(2):310–20.
MLA
Couchoud, Cécile, Davide Bolignano, Ionut Nistor, et al. “Dialysis Modality Choice in Diabetic Patients with End-stage Kidney Disease: a Systematic Review of the Available Evidence.” NEPHROLOGY DIALYSIS TRANSPLANTATION 30.2 (2015): 310–320. Print.
@article{5862621,
  abstract     = {BACKGROUND: Diabetes is the leading cause of end-stage kidney disease (ESKD). Because of conflicting results in observational studies, it is still subject to debate whether in diabetic patients the dialysis modality selected as first treatment (haemodialysis or peritoneal dialysis) may have a major impact on outcomes. We therefore aimed at performing a systematic review of the available evidence.
METHODS: MEDLINE, EMBASE and CENTRAL databases were searched until February 2014 for English-language articles without time or methodology restrictions by highly sensitive search strategies focused on diabetes, end-stage kidney disease and dialysis modality. Selection of relevant studies, data extraction and analysis were performed by two independent reviewers.
RESULTS: Twenty-five observational studies (23 on incident and 2 on prevalent cohorts) were included in this review. Mortality was the only main outcome addressed in large cohorts. When considering patient survival, results were inconsistent and varied across study designs, follow-up period and subgroups. We therefore found no evidence-based arguments in favour or against a particular dialysis modality as first choice treatment in patients with diabetes and ESKD. However, peritoneal dialysis (PD) as first choice seems to convey a higher risk of death in elderly and frail patients.
CONCLUSIONS: The available evidence derived from observational studies is inconsistent. Therefore evidence-based arguments indicating that HD or PD as first treatment may improve patient-centred outcomes in diabetics with ESKD are lacking. In the absence of such evidence, modality selection should be governed by patient preference, after unbiased patient information.},
  author       = {Couchoud, C{\'e}cile and Bolignano, Davide and Nistor, Ionut and Jager, Kitty J and Heaf, James and Heimburger, Olle and Van Biesen, Wim},
  issn         = {0931-0509},
  journal      = {NEPHROLOGY DIALYSIS TRANSPLANTATION},
  language     = {eng},
  number       = {2},
  pages        = {310--320},
  title        = {Dialysis modality choice in diabetic patients with end-stage kidney disease: a systematic review of the available evidence},
  url          = {http://dx.doi.org/10.1093/ndt/gfu293},
  volume       = {30},
  year         = {2015},
}

Altmetric
View in Altmetric
Web of Science
Times cited: