The relationship between different dialysis methods and septicemia: a systematic review and meta-analysis

Dear Editor,Kidney failure is a general term for heterogeneous disorders affecting kidney structure and function, which becomes a worldwide problems due to its frequency and high costs [1,2], and a...

All of the six studies proved that HD patients had a significantly higher proportion of bacteremia. The study by Wang et al. [11] included 366 patients treated with HD, 532 patients treated with PD. The study by Koch et al. [9] included 57 patients treated with HD and 66 patients treated with PD. The study by Aslam et al. [6] included 119 patients treated with HD and 62 patients treated with PD. The study by Powe et al. [10] included 4005 patients treated with HD, 913 patients treated with PD. The study by Foley et al. [7] included 344,648 patients treated with HD, 48,802 patients treated with PD. Jin et al. [8] included 82 patients treated with HD, 96 patients treated with PD. All these study provide odds ratio (OR) or risk ratio (RR). Previous study estimated that septicemia is associated with organ dysfunction, hypoperfusion or hypotension [12]. Pre-onset factors have a strong impact on the outcome of sepsis, thereby changing the disease process and treatment [13]. The pre-onset factors include the presence of comorbidities such as diabetes, and repetitive exposure to pathogens during hemodialysis [14].
Previous longitudinal study indicated that among 4918 ESRD patients found that sepsis was higher for HD (11.7%) than for PD patients (9.4%) [10]. Whether PD or HD treatment for ESRD patients is an important medical decision making for patients considering cost, quality of life and survival. Our findings are important for reducing the morbidity of septicemia among ESRD patients. As result of that, medical staff could tell the patients the different outcomes of PD and HD, and let them do the choices.
This study has some limitations. Firstly, due to the selected studies from the databases which could be search may be not sufficient, the relative lower statistical power with insufficient sample sizes is inevitable. Secondly, the hypothesis of normal distribution for random effects is against the principle of randomization in the inferential statistics [15]. Thirdly, it is difficult to do subgroup analyses according to demographic variables such as sex, age, and concurrent comorbidity because the selected studies did not include enough information. Future studies should be conducted to explore outcomes and confirm whether HD   ⨁⨁⨁ Moderate a The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds ratio GRADE Working Group grades of evidence -High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.
is an independent risk factor for septicemia. Finally, I 2 test seeks to determine whether there are real differences according to the findings of the selected studies, that is, heterogeneity, or whether the variation in results is reconcilable with chance alone, that is, homogeneity. I 2 values of 0-24.9%, 25-49.9%, 50-74.9%, and 75-100% were viewed as none, low, moderate, and high heterogeneity, respectively. In this study, we used the random-effect model when I 2 statistics was 85% more than 50%. However, we aggregate studies that are different methodologies, heterogeneity is still inevitable in the meta-analysis.
In conclusion, our study suggests a relationship between HD and septicemia among ESRD population. To further examine this finding and establish a stronger temporality, more large-scale prospective studies are warranted to provide more information about the details of the association between different dialysis treatments and septicemia. An increased rate of septicemia occurs in HD patients and clinicians should be aware of this possibility.