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

Abstract

Background: 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. Methods: 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. Results: 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) (HRRKF loss 1.873, 95%CI 1.475–2.378), DM (ORRKF 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. Conclusions: 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.