Peritoneal dialysis results in similar outcomes to extracorporeal dialysis in acute kidney injury: A systematic review and meta-analysis.

BackgroundThe choice of kidney replacement therapy (KRT) modality for treatment of dialysis requiring acute kidney injury (AKI-D) is underappreciated as a modifiable factor that can impact outcomes. Peritoneal dialysis (PD) and extracorporeal dialysis are both established modalities for treatment of kidney failure; their comparative effectiveness in AKI remains controversial. We conducted a systematic review and meta-analysis to compare clinical outcomes between PD and extracorporeal dialysis in patients with AKI.MethodsWe systematically searched Medline, Embase, and Cochrane Central Register of Controlled Trials from inception through November 2024 for randomized controlled trials comparing PD with extracorporeal dialysis in adult patients with AKI requiring KRT. The primary outcome was mortality. Secondary outcomes included kidney function recovery, time to kidney function recovery, and infectious complications. We conducted meta-analyses using random-effects models and assessed risk of bias using the Cochrane Risk of Bias tool 2.0.ResultsAbout 358 records were identified, of which 7 were included in quantitative meta-analysis. We found no significant difference in mortality between PD and extracorporeal dialysis (odds ratio [OR] 1.05; 95% confidence interval [CI], 0.62-1.76; p = 0.87). Event rates were similar between groups (PD: 56.1%, extracorporeal: 56.5%). Kidney function recovery rates were comparable (OR 1.26; 95% CI, 0.81-1.95; p = 0.30), though time to kidney function recovery was significantly shorter with PD (mean difference -3.34 days, 95% CI -3.95 to -2.73, p < 0.00001). Infection rates were similar between modalities (OR 1.02, 95% CI 0.47-2.22, p = 0.96).ConclusionThis meta-analysis demonstrates comparable clinical outcomes between PD and extracorporeal dialysis for AKI management across key metrics including mortality, kidney function recovery, and infectious complications. PD was associated with faster time to kidney function recovery. These findings support the use of PD as an equally effective treatment for AKI-D. Further research is needed to evaluate patient-reported outcomes and patient modality preference.