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Dialysis modality and cognitive outcomes in chronic kidney disease: a systematic review and meta-analysis

Ali Malik1, Hamid Reza Khademi Mansour2, Sukruth Pradeep Kundur2

  • 1Faculty of Life Sciences and Medicine, King's College London, London, UK. ali.t.malik@kcl.ac.uk.

Clinical and Experimental Nephrology
|December 1, 2025
PubMed

Insights

Peritoneal dialysis (PD) may offer better cognitive outcomes than hemodialysis (HD) for chronic kidney disease (CKD) patients. This meta-analysis found PD associated with improved cognitive function and lower dementia risk, suggesting personalized dialysis choices.

Area of Science:

  • Nephrology
  • Neurology
  • Public Health

Background:

  • Cognitive impairment is common in chronic kidney disease (CKD) patients.
  • Hemodialysis (HD) and peritoneal dialysis (PD) are key renal replacement therapies.
  • The comparative impact of HD versus PD on cognitive health is not well-established.

Purpose of the Study:

  • To compare cognitive outcomes between hemodialysis (HD) and peritoneal dialysis (PD) in patients with chronic kidney disease (CKD).
  • To evaluate the incidence of dementia in patients undergoing HD versus PD.

Main Methods:

  • A systematic literature search was conducted across multiple databases (PubMed, CENTRAL, Embase, etc.) from January 2000 to January 2025.
  • Included are cohort studies of adult CKD patients comparing HD and PD.
  • A random-effects meta-analysis was employed to assess cognitive function and dementia incidence, with risk of bias and evidence quality rigorously evaluated.

Main Results:

  • The meta-analysis included 26 studies with 326,216 patients.
  • Significant differences in overall cognitive function (SMD: -0.46) and dementia incidence (OR: 1.68) were observed between HD and PD groups.
  • Peritoneal dialysis (PD) showed potential advantages in executive function, verbal memory, and cognitive stability.

Conclusions:

  • Quantitative and qualitative analyses indicate that PD may be linked to superior cognitive outcomes in specific domains compared to HD.
  • Individualizing dialysis modality selection based on cognitive risk profiles is recommended.
  • Further standardized research is necessary to confirm these findings.
Abstract

Keywords:
Chronic kidney diseaseHaemodialysisPeritoneal dialysis

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