A Comparison of Clinical Outcomes in Urgent-Start Hemodialysis versus Urgent-Start Peritoneal Dialysis in End-Stage Renal Disease Patients: A Systematic Review and Meta-Analysis

INTRODUCTION: Current evidence indicates that for patients requiring renal replacement therapy, USPD may correlate with reduced complications and lower mortality rates compared to USHD. However, there is a lack of literature specifically addressing its application and results in individuals with ESRD. A comprehensive examination and synthesis of existing research were conducted to compare fellow-up outcomes of USPD versus USHD in ESRD patients. METHODS: A comprehensive search was conducted in PubMed, Web of Science, and the Cochrane Library, and SpringerLink databases for that compare USPD to USHD before November 1, 2024. Mortality, all complications, noninfectious complications, infectious complications, bacteremia, and peritonitis were used as outcomes to compare USPD and USHD. RESULTS: This meta-analysis incorporated seven studies involving a total of 1,338 patients. Our findings showed no notable distinctions in peritonitis between USPD and USHD. urgent-start PD was linked to a reduced mortality rate "(OR: 0.48, 95% CI: 0.24-0.95, p < 0.05), lower all complications (OR: 0.27, 95% CI: 0.20-0.37, p < 0.05), lower noninfectious complications (OR: 0.32, 95% CI: 0.23-0.45, p < 0.05), lower infectious complications (OR: 0.29, 95% CI: 0.17-0.51, p < 0.05), lower bacteremia (OR: 0.18, 95% CI: 0.07-0.42, p < 0.05)" compared to USHD. CONCLUSIONS: Our findings indicate that among patients with ESRD, those undergoing urgent-start PD have lower risks during the follow-up period compared to those receiving USHD. USPD is associated with significantly reduced all-cause mortality, overall complications, infectious complications, noninfectious complications, and bacteremia incidence. The results indicate that USPD could potentially function as an appropriate replacement for USHD. However, further high-quality clinical studies still are necessary to substantiate this conclusion.