Thongprayoon, Charat

ABSTRACTBackgroundComplications related to peritoneal dialysis (PD) in patients with autosomal‐dominant polycystic kidney disease (ADPKD), including intraperitoneal rupture of renal cyst, hernia, membrane failure and peritonitis, have been reported. However, long‐term clinical outcomes of ADPKD patients on PD remain unclear. We performed this meta‐analysis to assess the risks of death, technique failure and peritonitis in ADPKD patients on PD.MethodsA systematic review was conducted using MEDLINE, EMBASE and Cochrane databases from inception to October 2017 to identify studies that evaluated the outcomes of ADPKD patients on PD, including the risks of death, technique failure and peritonitis. Non‐ADPKD patients on PD were used as controls. Effect estimates from the individual study were extracted and combined using the random‐effect, generic inverse variance method of DerSimonian and Laird.ResultsTwelve cohort studies with a total of 14 673 patients on PD (931 ADPKD and 13 742 non‐ADPKD patients) were enrolled. Compared with non‐ADPKD status, ADPKD was associated with significantly decreased mortality risk with pooled odds ratio (OR) of 0.68 (95% confidence interval (CI), 0.53–0.86; I2 = 0). There were no associations of ADPKD with the risks of technique failure of PD and peritonitis with pooled OR of 0.93 (95% CI, 0.79–1.10; I2 = 0) and 0.88 (95% CI, 0.75–1.05; I2 = 0), respectively. We found no publication bias as assessed by Egger's regression asymmetry test, with P = 0.90, 0.28 and 0.60 for the risks of mortality, technique failure and peritonitis in ADPKD patients on PD, respectively.ConclusionCompared with non‐ADPKD patients on PD, our study demonstrates that ADPKD patients on PD have 0.68‐fold decreased mortality risk. There are no associations of ADPKD status with the risks of technique failure or peritonitis.

ABSTRACTAimPrevious studies have suggested a higher incidence of urologic malignancies in end‐stage renal disease (ESRD) patients. However, incidence trends of urologic malignancies in ESRD patients remain unclear. The aims of the present study were: (i) to investigate the pooled incidence/incidence trends; and (ii) to assess the risk of urologic malignancies in ESRD patients.MethodsA literature search was conducted using MEDLINE, EMBASE and Cochrane Database from inception through April 2017. Studies that reported incidence or odds ratios of urologic malignancies among ESRD patients were included. Pooled odds ratios (OR) and 95%CI were calculated using a random‐effect model. The protocol for this meta‐analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42017067687).ResultsNineteen observational studies with 1 931 073 ESRD patients were enrolled. The pooled estimated incidence of kidney cancer and urothelial cancers (carcinomas of the bladder, ureters, and renal pelvis) in ESRD patients were 0.3% (95%CI: 0.2–0.5%) and 0.5% (95%CI: 0.3–0.8%), respectively. Meta‐regression showed significant positive correlation between incidence of urologic malignancies in ESRD patients and year of study (slopes = +0.05 and +0.07, P < 0.001 for kidney cancer and urothelial cancers, respectively). Compared to non‐ESRD status, ESRD was significantly associated with both kidney cancer (pooled OR 6.04; 95% CI 4.70–7.77) and urothelial cancers (pooled OR 4.37; 95% CI 2.40–7.96).ConclusionOur study demonstrates a significant association between ESRD and urologic malignancies. The overall estimated incidence rates of kidney cancer and urothelial cancers are 0.4% and 0.5%, respectively. There is a significant positive correlation between the incidence of urologic malignancies and year of study.