Comparison of cardiovascular mortality in hemodialysis versus peritoneal dialysis
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NEPHROLOGY - REVIEW
Comparison of cardiovascular mortality in hemodialysis versus peritoneal dialysis Cheng Han Ng1 · Zhi Hao Ong1 · Hersharan Kaur Sran1,2 · Teo Boon Wee1,2 Received: 14 July 2020 / Accepted: 12 October 2020 © Springer Nature B.V. 2020
Abstract Purpose Cardiovascular disease is a significant cause of morbidity and mortality in dialysis patients. With the increasing prevalence of dialysis patients, there is a need to systematically identify the epidemiology of cardiovascular disease in hemodialysis and peritoneal dialysis patients. Methods A meta-analysis was conducted in reference to the MOOSE and PRISMA guidelines. Database searches were conducted on Medline and Embase on 17 March 2020. Meta-analysis of proportions was used to summarize the overall prevalence of events. Pairwise comparisons were used to compare between hemodialysis and peritoneal dialysis, and metaregression was applied to identify the factors influencing disease. Results A total of 28 studies were included in the review and prevalence of cardiovascular disease events including coronary artery disease, coronary artery complications, congestive heart failure, peripheral arterial disease, atrial fibrillation, and cardiovascular mortality were summarized. Atrial fibrillation (RR 1.287 CI 1.154–1.436, p 18 years old). The outcome of interest included cardiovascular events, such as coronary artery disease (CAD), CAD complications comprising ischemic heart disease and myocardial infarction, peripheral arterial disease (PAD), congestive heart failure (CHF), atrial fibrillation (AF), and cardiac mortality. Duplicated articles using the same cohort of patients in their analysis were excluded. Screening of abstracts and full texts was done by two authors, and discrepancies removed by a third author. The blinded pair then independently extracted general
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International Urology and Nephrology
demographics (author, year, country), characteristics of included patients (sample size, age, gender, diabetes) and binary event rates in HD and PD group.
Statistical analysis and assessment of quality Statistical analysis was conducted for proportions, pairwise comparisons and meta-regression. A meta-analysis of proportions was conducted with metaprop to pool the overall prevalence in HD and PD individually [11]. Freeman–Tukey double arcsine transformation was performed to stabilize the variance from the raw data before the results were pooled with DerSimonian and Laird random effects model [11]. Next, comparative meta-analysis was conducted to compared between the prevalence of events between HD and PD. Regardless of heterogenicity measured by the I2, tau and Cochran Q test [12, 13], a random effect by DerSimonian and Laird model was used in the pooled analysis of risk ratios (RR) [14]. Lastly, heterogenicity was explored with meta-regression (mean age, proportion of males, diabetes) with random effect using the residual maximum likelihood (REML) model and Knapp–Hartung variance estimator [15, 16]. When mean age was not reported, transform
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