Influencing factors for residual kidney function in incident peritoneal dialysis patients: a systematic review and meta-analysis

Residual kidney function (RKF) impacts patients’ survival rate and quality of life when undergoing peritoneal dialysis (PD). This meta-analysis was conducted to systematically identify risk and protective factors associated with RKF decline and loss. We searched three English and one Chinese databases from inception to January 31, 2023, for cohort and cross-sectional studies exploring factors associated with RKF decline or loss. The random effects model was employed to aggregate risk estimates and 95% confidence intervals (CIs) from multivariate analysis. Sensitivity and subgroup analyses were performed to explore the heterogeneity among the studies. Twenty-seven studies comprising 13549 individuals and 14 factors were included in the meta-analysis. Based on the meta-analysis results, risk factors involving male gender (hazard ratio (HR) 1.689, 95%CI 1.385–2.061), greater body mass index (BMI) (odds ratio (OR) 1.081, 95% confidence interval (CI) 1.029–1.135), higher systolic blood pressure (SBP) (HR 1.014, 95%CI 1.005–1.024), diabetes mellitus (DM) (HR_{RKF loss} 1.873, 95%CI 1.475–2.378), DM (OR_{RKF decline} 1.906, 95%CI 1.262–2.879), peritonitis (relative ratio (RR) 2.291, 95%CI 1.633–3.213), proteinuria (OR 1.223, 95%CI 1.117–1.338), and elevated serum phosphorus (RR 2.655, 95%CI 1.679–4.201) significantly contributed to the risk of RKF decline and loss in PD patients. Conversely, older age (HR 0.968, 95%CI 0.956–0.981), higher serum albumin (OR 0.834, 95%CI 0.720–0.966), weekly Kt/V urea (HR 0.414, 95%CI 0.248–0.690), baseline urine volume (UV) (HR 0.791, 95%CI 0.639–0.979), baseline RKF (HR 0.795, 95%CI 0.739–0.857) exhibited protective effects. However, diuretics use, automatic peritoneal dialysis (APD) modality and baseline RKF did not significantly impact RKF decline. Patients with male gender, greater BMI, higher SBP, DM, peritonitis, proteinuria, and elevated serum phosphorus might have a higher risk of RKF decline and loss. In contrast, older age, higher serum albumin, weekly Kt/V urea, baseline UV, and baseline RKF might protect against RKF deterioration.

残余肾功能 (Residual kidney function, RKF) 可影响腹膜透析 (Peritoneal dialysis, PD) 患者的生存率与生活质量。本项荟萃分析 (meta-analysis) 旨在系统明确与RKF下降及丧失相关的危险因素与保护因素。我们检索了建库至2023年1月31日的3个英文数据库与1个中文数据库，筛选探讨RKF下降或丧失相关影响因素的队列研究及横断面研究。采用随机效应模型合并多变量分析得到的风险估计值与95%置信区间 (Confidence intervals, CIs)。通过敏感性分析与亚组分析探究研究间的异质性。本荟萃分析共纳入27项研究，涉及13549名受试者与14个影响因素。基于荟萃分析结果，男性性别 (风险比 (Hazard ratio, HR) 1.689，95%CI 1.385~2.061)、较高的体重指数 (Body mass index, BMI) (优势比 (Odds ratio, OR) 1.081，95%置信区间1.029~1.135)、较高的收缩压 (Systolic blood pressure, SBP) (HR 1.014，95%CI 1.005~1.024)、糖尿病 (Diabetes mellitus, DM，针对RKF丧失的HR为1.873，95%CI 1.475~2.378；针对RKF下降的OR为1.906，95%CI 1.262~2.879)、腹膜炎 (peritonitis，相对危险度 (Relative ratio, RR) 2.291，95%CI 1.633~3.213)、蛋白尿 (proteinuria，OR 1.223，95%CI 1.117~1.338) 以及血清磷水平升高 (RR 2.655，95%CI 1.679~4.201) 均会显著增加PD患者RKF下降与丧失的风险。反之，年龄更大 (HR 0.968，95%CI 0.956~0.981)、较高的血清白蛋白水平 (serum albumin，OR 0.834，95%CI 0.720~0.966)、每周尿素Kt/V值 (weekly Kt/V urea，HR 0.414，95%CI 0.248~0.690)、基线尿量 (Baseline urine volume, UV，HR 0.791，95%CI 0.639~0.979) 以及基线RKF (HR 0.795，95%CI 0.739~0.857) 则表现出保护作用。不过，利尿剂使用、自动化腹膜透析 (Automatic peritoneal dialysis, APD) 模式与基线RKF并未对RKF下降产生显著影响。综上，男性、较高BMI、较高SBP、糖尿病、腹膜炎、蛋白尿及血清磷水平升高的PD患者，其RKF下降与丧失的风险可能更高；而年龄更大、血清白蛋白水平更高、每周尿素Kt/V值更高、基线尿量更多以及基线RKF水平更高的患者，则可能延缓RKF恶化。