INTRODUCTION AND AIMS: Several studies have demonstrated that end stage renal disease (ESRD) patients on dialysis are at higher risk for cerebrovascular events, especially those on hemodialysis. However, the risk of stroke in patients on peritoneal dialysis (PD) compared to those on hemodialysis (HD) remains unclear. We performed this meta-analysis to assess the risks of stroke in ESRD patients on PD compared to HD.
METHODS: A systematic review was conducted in MEDLINE, EMBASE, Cochrane databases from inception through December 2017 to identify studies that evaluated outcomes of patients on different dialysis modalities including the risks of stroke (all types of stroke, ischemic stroke or hemorrhagic stroke). Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird
RESULTS: 12 observational studies with a total of 1,276,677 dialysis patients (over 1,131,396 on HD and 119,185 on PD) were enrolled. Compared with HD, PD was associated with significantly decreased risk of hemorrhagic stroke with pooled OR of 0.84 (95% CI, 0.76-0.93, I2= 0). There was no difference in risk of all stroke or ischemic stroke in those on PD compared to HD with pooled ORs of 1.03 (95% CI, 0.98-1.09, I2= 84.8) and 0.92 (95% CI, 0.76-1.11, I2= 89.9), respectively. We found no publication bias as assessed by the funnel plots and Egger’s regression asymmetry test with p= 0.56 and 0.73 for the risks of hemorrhagic stroke and all type of stroke on PD compared to HD, respectively. However, the publication bias was present with p=0.02 for the risk of ischemic stroke.
CONCLUSIONS: PD status is associated with 16% lower risk of hemorrhagic stroke compared to HD, but the risks of all types of stroke and hemorrhagic stroke are not statistically different in PD patients, when compared to HD patients.
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