背景:腹膜透析(PD)是一种针对肾衰竭患者的家庭肾脏替代疗法(KRT)。PD可以通过手动填充和引流腹腔来进行,即连续非卧床PD(CAPD),或使用连接到PD导管的设备,该设备被编程为执行PD交换,即自动PD(APD)。APD被认为比CAPD有几个优点,例如腹膜炎的发病率较低,更少的机械并发症,和更大的社会心理接受度。承认在接受PD的事件和流行患者中APD的摄取增加,与CAPD相比,重新评估APD的临床和患者报告结局的对比证据非常重要.这是2007年发布的Cochrane评论的更新。
目的:比较肾功能衰竭患者APD与CAPD的临床和患者报告结果。
方法:在此更新中,我们检索了Cochrane肾脏和移植研究登记册,直至2024年8月29日.登记册中的研究是通过对CENTRAL的搜索确定的,MEDLINE,和EMBASE,会议记录,国际临床试验注册平台(ICTRP)搜索门户,和ClinicalTrials.gov.
方法:在肾功能衰竭的成人(≥18岁)中比较APD和CAPD的随机对照试验(RCT)。
方法:两位作者独立筛选搜索结果并提取数据。使用随机效应荟萃分析进行数据合成,将效果估计表示为风险比(RR),对于二分数据具有95%置信区间(CI),对于连续数据具有95%CIs的平均差(MD)。使用建议分级评估来评估证据的确定性,开发和评估(等级)方法。
结果:本次更新包括两个RCT(131名随机人群)比较APD和CAPD。一个RCT随访了六个月,1例RCT随访24个月.纳入研究的偏倚风险大多较低,除了主观结果的表现偏差的高风险。与CAPD相比,APD对死亡的影响的证据非常不确定,住院治疗,PD相关性腹膜炎,透析方式的改变,残余肾功能,健康相关生活质量(HRQoL),过度水合,血压,出口部位感染,隧道感染,机械性并发症,PD导管移除,或透析充分性措施。这些结果在很大程度上是基于低到非常低的确定性证据;因此,得出结论时应谨慎行事。
结论:没有足够的证据来决定APD和CAPD在肾衰竭患者的临床和患者报告的结局。因此,目前的证据不足以作为临床实践的指导。鉴于现有研究的样本量通常很小,随访不足,需要大规模,多中心研究。未来的研究应该集中在APD和CAPD在残余肾功能方面的可能差异。正常人血,和患者报告的结果,如HRQoL,症状,患者满意度和生活参与度。
BACKGROUND: Peritoneal dialysis (PD) is a home-based kidney replacement therapy (KRT) performed in people with kidney failure. PD can be performed by manual filling and draining of the abdominal cavity, i.e. continuous ambulatory PD (CAPD), or using a device connected to the PD catheter that is programmed to perform PD exchanges, i.e. automated PD (APD). APD is considered to have several advantages over CAPD, such as a lower incidence of peritonitis, fewer mechanical complications, and greater psychosocial acceptability. Acknowledging the increasing uptake of APD in incident and prevalent patients undergoing PD, it is important to re-evaluate the evidence on the comparative clinical and patient-reported outcomes of APD compared to CAPD. This is an update of a Cochrane review published in 2007.
OBJECTIVE: To compare clinical and patient-reported outcomes of APD to CAPD in people with kidney failure.
METHODS: In this update, we searched the Cochrane Kidney and Transplant Register of Studies until 29 August 2024. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov.
METHODS: Randomised controlled trials (RCTs) comparing APD with CAPD in adults (≥ 18 years) with kidney failure.
METHODS: Two authors independently screened the search results and extracted data. Data synthesis was performed using random-effects meta-analyses, expressing effect estimates as risk ratios (RR) with 95% confidence intervals (CI) for dichotomous data and mean differences (MD) with 95% CIs for continuous data. Certainty in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
RESULTS: Two RCTs (131 randomised people) comparing APD with CAPD were included in this update. One RCT had a follow-up of six months, and one RCT had a follow-up of 24 months. The risk of
bias in the included studies was mostly low, except for the high risk of performance
bias for subjective outcomes. The evidence is very uncertain about the effect of APD compared to CAPD on death, hospitalisations, PD-related peritonitis, change of dialysis modality, residual kidney function, health-related quality of life (HRQoL), overhydration, blood pressure, exit-site infections, tunnel infections, mechanical complications, PD catheter removal, or dialysis adequacy measures. These results were largely based on low to very low certainty evidence; hence, caution is warranted when drawing conclusions.
CONCLUSIONS: Insufficient evidence exists to decide between APD and CAPD in kidney failure patients with regard to clinical and patient-reported outcomes. Therefore, current evidence is insufficient as a guide for clinical practice. Given that the sample sizes of existing studies are generally small with insufficient follow-up, there is a need for large-scale, multicentre studies. Future research should focus on possible differences between APD and CAPD in residual kidney function, euvolaemia, and patient-reported outcomes such as HRQoL, symptoms, patient satisfaction and life participation.