Supplementary Material for: Association of hypoalbuminemia with the risk of peritoneal dialysis-associated peritonitis in peritoneal dialysis patients: a meta-analysis

Introduction: The purpose of this meta-analysis was to assess the association between hypoalbuminemia and the risk of peritoneal dialysis-associated peritonitis (PDAP) in patients receiving peritoneal dialysis (PD).
Methods: By the specified deadline of November 13, 2023, a systematic search across various databases was conducted to identify relevant literature. The databases searched included PubMed, Embase, the Cochrane Library, Web of Science, the China National Knowledge Infrastructure (CNKI), WanFang, and VIP. The effect sizes were quantified using odds ratios (OR) or hazard ratios (HR) and were presented with 95% confidence intervals (CI). The analysis was stratified by the type of PD [continuous ambulatory peritoneal dialysis (CAPD), mixed] and the timing of albumin (ALB) level measurements (at baseline, after initiation of PD, or average over time).
Results: A total of 14 studies encompassing 6,448 PD patients were incorporated in this meta-analysis. The findings revealed a significantly elevated risk of peritonitis in patients with hypoalbuminemia compared to those with an ALB level above 3.5g/dL (OR: 2.70, 95% CI: 1.78 to 4.09, P <0.001). Stratification by PD modality showed consistent results within the CAPD group (OR: 5.79, 95% CI: 3.57 to 9.41, P <0.001). For the timing of ALB measurements, the baseline measurement group maintained these findings (OR: 2.53, 95% CI: 1.40 to 4.58, P =0.002), while the group with post-PD measurements did not show statistical significance (OR: 0.76, 95% CI: 0.49 to 1.17, P =0.212). The HR analysis similarly indicated an increased risk of peritonitis in hypoalbuminemia patients compared to those with higher serum ALB levels (HR: 1.62, 95% CI: 1.44 to 1.82, P <0.001).
Conclusion: Our meta-analysis reveals that hypoalbuminemia raises the risk of peritonitis in PD patients, particularly at baseline. This finding underscores the need for close monitoring to detect peritonitis early. Further research is needed to understand the impact of ALB levels post-PD initiation on peritonitis risk.

引言：本荟萃分析旨在探讨低白蛋白血症（hypoalbuminemia）与接受腹膜透析（peritoneal dialysis, PD）患者发生腹膜透析相关性腹膜炎（peritoneal dialysis-associated peritonitis, PDAP）的风险关联。
方法：截至2023年11月13日，本研究系统检索了多个数据库以筛选相关文献，检索数据库包括PubMed、Embase、Cochrane图书馆、Web of Science、中国知网（China National Knowledge Infrastructure, CNKI）、万方及维普（VIP）。采用比值比（odds ratios, OR）或风险比（hazard ratios, HR）量化效应量，并以95%置信区间（confidence intervals, CI）呈现结果。分析按腹膜透析类型[持续性非卧床腹膜透析（continuous ambulatory peritoneal dialysis, CAPD）、混合型]及白蛋白（albumin, ALB）检测时机（基线时、腹膜透析启动后、长期平均水平）进行分层。
结果：本荟萃分析共纳入14项研究，涉及6448例腹膜透析患者。结果显示，与血清白蛋白水平≥3.5g/dL的患者相比，低白蛋白血症患者的腹膜炎发生风险显著升高（OR=2.70，95%CI：1.78~4.09，P<0.001）。按透析方式分层分析显示，持续性非卧床腹膜透析亚组结果一致（OR=5.79，95%CI：3.57~9.41，P<0.001）。按白蛋白检测时机分层，基线检测亚组仍保留该关联（OR=2.53，95%CI：1.40~4.58，P=0.002），而腹膜透析启动后检测亚组未显示统计学显著性（OR=0.76，95%CI：0.49~1.17，P=0.212）。风险比分析同样表明，低白蛋白血症患者较血清白蛋白水平更高的患者腹膜炎风险升高（HR=1.62，95%CI：1.44~1.82，P<0.001）。
结论：本荟萃分析结果显示，低白蛋白血症会升高腹膜透析患者的腹膜炎风险，尤以基线白蛋白水平异常时为甚。该发现提示需加强监测以早期识别腹膜炎。未来仍需进一步研究以明确腹膜透析启动后白蛋白水平对腹膜炎风险的影响。