Impact of dialysis modality on survival after kidney transplant failure: A systematic review and meta-analysis

We reviewed evidence on survival of dialysis after graft failure (DAGF) patients based on the selected dialysis modality (peritoneal dialysis [PD] vs hemodialysis[HD]).

PubMed, CENTRAL, Embase, Scopus, and Web of Science were searched for all type of studies comparing PD with HD in DAGF patients and reporting survival rates, technique survival or complications. The last date of the search was May 5, 2024. The Newcastle-Ottawa Scale was used to assess study quality. We extracted both crude and multivariable-adjusted data from the studies for the meta-analysis which were pooled as odds ratio (OR) and Hazard ratios (HR) respectively. Outcomes were assessed at the longest follow-up of the included studies.

Seven studies were included comparing 2494 patients on PD and 4041 patients on HD. Meta-analysis of crude data showed that mortality rates did not differ between PD and HD in patients receiving DAGF (OR: 0.98 95% CI: 0.76, 1.27 I²=50%). Meta-analysis of adjusted data also showed that the dialysis modality (PD or HD) had no impact on survival rates in patients receiving DAGF (HR: 0.93 95% CI: 0.73, 1.18 I²=50%). Sensitivity analysis did not change the significance of the results. Data was limited for other outcomes.

Very-:low quality evidence mostly from retrospective studies shows that dialysis modality may not impact survival rates in patients returning to DAGF. There is a need for robust randomized controlled trials with large sample sizes to provide better evidence.