Abstract
BackgroundRegarding lupus disease activity, morbidity and survival, limited literature concluded conflicting results when comparing hemodialysis versus peritoneal dialysis as initial renal replacement therapies (RRT) prior to transplantation, in lupus nephritis end-stage renal disease (LN-ESRD) patients. This study was aimed to compare the risks of lupus flares, all-cause infections, all-cause cardiovascular events, and mortality, between hemodialysis versus peritoneal dialysis as initial RRT - modality before renal-transplant in LN-ESRD patients, by systematic review and meta-analysis.MethodsPubMed, EMBASE, and SCOPUS were searched for observational-studies comparing LN-ESRD -patients undergoing hemodialysis (Group1) versus peritoneal-dialysis (Group 2) prior to renal-transplantation, by their risks of lupus flare, all-cause infections, all-cause cardiovascular events, and mortality as outcome measures. Relative-Risks of outcomes between the groups measured overall effects at a 95% significance level. RevMan 5.3 computer software was used for analysis.ResultsFrom search, 16 eligible studies reported 15,636 LN-ESRD -patients prior to renal transplantation with 4616 patients on hemodialysis, 2089 on peritoneal dialysis, 280 directly underwent kidney transplantation, 8319 were eliminated with reasons and 332 participants’ details were not reported. Hemodialysis group had higher risk of all-cause cardiovascular events, Relative-Risk = 1.44 (Confidence Interval:1.02, 2.04), p-Value< 0.05. With regards to risks for mortality, flare and all-cause infections, there were trends that were not statistically significant (p-Value> 0.05).ConclusionExcept for all-cause cardiovascular events in which peritoneal dialysis is superior to hemodialysis offering better outcomes, both treatment modalities offer more or less similar clinical outcomes as effective initial choices of RRT in LN-ESRD patients prior to renal transplant.The protocol registrationPROSPERO 2019 CRD42019131600.
Highlights
Regarding lupus disease activity, morbidity and survival, limited literature concluded conflicting results when comparing hemodialysis versus peritoneal dialysis as initial renal replacement therapies (RRT) prior to transplantation, in lupus nephritis end-stage renal disease (LN-End-stage renal disease (ESRD)) patients
ESRD results from an ultimate complication of underlying renal debilitating chronic conditions that could range from systemic diseases such as diabetes, hypertension, inflammatory conditions such as glomerulonephritis and tubulointerstitial nephritis, autoimmune disorders like systemic lupus erythematosus (SLE), genetic disorders including polycystic kidney diseases to chronic urinary tract infections and obstructive conditions [1,2,3,4]
Search Preliminary search from online databases using a combination of terms in the advanced search tool and Medical subject headings (MeSH) terms resulted in 302 studies
Summary
Morbidity and survival, limited literature concluded conflicting results when comparing hemodialysis versus peritoneal dialysis as initial renal replacement therapies (RRT) prior to transplantation, in lupus nephritis end-stage renal disease (LN-ESRD) patients. This study was aimed to compare the risks of lupus flares, all-cause infections, all-cause cardiovascular events, and mortality, between hemodialysis versus peritoneal dialysis as initial RRT - modality before renal-transplant in LN-ESRD patients, by systematic review and meta-analysis. SLE pathogenesis results from the formation of autoantibodies, activation of serum complements, and deposition of immune complexes in various tissues followed by the initiation of inflammation. The deposition of these immune complexes and their associated inflammations in the kidneys result in lupus nephritis [5]. About 60% of SLE patients will eventually complicate to lupus nephritis, with male gender and black ancestry in preference [1, 6]
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