Effectiveness of Automated Peritoneal Dialysis Compared to Outpatient Procedure: A Systematic Review and Meta-analysis Study

Sajjad  Dorri Kafrani; Hosein Shabaninejad; Sodabeh Vatankhah; Mohammadreza Maleki

doi:10.18502/ssu.v29i12.8971

Sajjad Dorri Kafrani Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Hosein Shabaninejad Department of Health Care Management, School of Management of Information, Iran University of Medical Sciences, Tehran, Iran.
Sodabeh Vatankhah Department of Health Care Management, School of Management of Information, Iran University of Medical Sciences, Tehran, Iran.
Mohammadreza Maleki Department of Health Care Management, School of Management of Information, Iran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/ssu.v29i12.8971

Keywords: Continuous Ambulatory Peritoneal Dialysis, Automated Peritoneal Dialysis, End Stage Renal Disease, CAPD, APD, ESRD.

Abstract

Introduction: The growing trend of renal failure has focused clinical therapy on the cost-effective alternatives such as peritoneal dialysis. Therefore, the present study has investigated the effectiveness of two methods of continuous and automatic peritoneal dialysis in the patients with end stage renal disease.

Methods: This study was conducted in the form of a systematic review. Advanced search was done in PubMed, Cochrane Library, Scopus databases, and in title, abstract, and keyword fields without any restrictions. The inclusion criteria included clinical trial research focused on two methods of peritoneal dialysis. The process of data extraction was performed, using a standard checklist. The quality of the studies was evaluated by the Cochrane quality assessment checklist and the results of the indicators were analyzed in the form of meta-analysis.

Results: A total of 5 clinical trials, including 311 patients, were included in the study. All studies had high quality. Automated method has the advantage of continuous procedure in terms of complications such as mortality (RR 1.42, 95% CI 0.48 to 4.21), peritonitis (RR: 0.80, 95% CI 0.50 to 1.29), exit-site (RR:1.07,95% CI 0.52 to 2.15) and tunnel (RR 1.01,95%CI 0.18 to 5.67). The kt/v index was better in the automatic method than the continuous method (SMD 0.37, 95%CI 0.01 to 0.73), on the other hand, creatinine clearance in the continuous method was better than the automatic method (SMD -0.40, 95%CI 0.78 to 0.02).

Conclusion: The side effects of the two treatment methods did not differ, but considering the indicators of dialysis adequacy, creatinine clearance was performed better in the continuous outpatient method, while the results of the kt/v index in the automatic method were better. In terms of cost items, along with clinical indicators, it seems that final decision-making for macro-health policies has helped.