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Seminars in Dialysis 2024The timing of peritoneal dialysis (PD) initiation, whether conventional-start (planned) or urgent-start (unplanned), may impact the outcomes of PD and the rate of... (Meta-Analysis)
Meta-Analysis Comparative Study Review
The timing of peritoneal dialysis (PD) initiation, whether conventional-start (planned) or urgent-start (unplanned), may impact the outcomes of PD and the rate of associated complications in individuals with chronic kidney disease (CKD). The goal of this study was to evaluate the effects of unplanned/urgent-start PD versus conventional-start PD in this cohort of patients. Electronic search of MEDLINE (via PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus databases was done from inception until July 2023 for studies reporting outcomes of unplanned/urgent-start and conventional-start PD in CKD patients. Outcomes of interest included mechanical complications, post-procedure infections, mortality, and transfer to hemodialysis. Heterogeneity, publication bias, and the influence of individual studies on the pooled odds ratio (OR) with 95% confidence interval (CI) were evaluated. Twenty-seven studies were finally included in the review. The overall risk of post-procedure infectious was comparable for both PD initiation methods (OR: 1.05; 95% CI: 0.83-1.34). Similarly, the risks for peritonitis and exit site infections did not differ significantly. However, urgent-start PD correlated with a significantly higher risk of overall mechanical complications (OR: 1.70; 95% CI: 1.23-2.34). Specifically, the risk for leaks was notably higher (OR: 2.47; 95% CI: 1.67-3.65) in the urgent-start group compared to the conventional-start PD group. Urgent-start PD correlated with significantly increased mortality rates (OR: 1.83; 95% CI: 1.39-2.41). There was no difference in the likelihood of technique survival and transfer to hemodialysis. Both urgent-start and conventional-start PD correlated with similar risks of overall infectious complications. Urgent-start PD resulted in significantly increased risks of mechanical complications and mortality. Our findings emphasize the need for meticulous planning and consideration when opting for PD initiation.
Topics: Humans; Peritoneal Dialysis; Kidney Failure, Chronic; Peritonitis
PubMed: 38477178
DOI: 10.1111/sdi.13198 -
BMC Infectious Diseases Aug 2023Spontaneous bacterial peritonitis (SBP) is a life-threatening complication in patients with advanced cirrhosis. Prophylactic Norfloxacin used to be considered effective... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Spontaneous bacterial peritonitis (SBP) is a life-threatening complication in patients with advanced cirrhosis. Prophylactic Norfloxacin used to be considered effective in SBP prevention, but in recent years its efficacy has been partially compromised by increasing quinolone-resistant bacteria. However, whether the effects of alternative prophylactic regimens are superior to norfloxacin remains controversial. The goal of this study is to compare the effects of norfloxacin with other antibiotics in SBP prophylaxis for cirrhotic patients.
METHODS
We systematically searched Pubmed, Embase, and Cochrane Library Databases. Two reviewers independently identified relevant random control trials (RCTs) comparing the role of norfloxacin and other antibiotics in SBP prevention.
RESULTS
Eight studies comprising 1043 cirrhotic patients were included in this study. Norfloxacin and alternative antibiotics displayed comparable effects in SBP prophylaxis, survival benefit, overall infection prevention, and safety. Subgroup analyses revealed that rifaximin prophylaxis could reduce the recurrence of SBP with fewer adverse events but failed to improve overall survival compared with norfloxacin.
CONCLUSIONS
Other antibiotics are a reasonable alternative to norfloxacin in the prophylaxis of SBP. Rifaximin prophylaxis could be an alternative choose of antibiotic for SBP prevention because of its better protective effect and safety.
Topics: Humans; Norfloxacin; Anti-Bacterial Agents; Rifaximin; Liver Cirrhosis; Quinolones
PubMed: 37641014
DOI: 10.1186/s12879-023-08557-6 -
BMC Nephrology Mar 2024Patient experiences and survival outcomes can be influenced by the circumstances related to dialysis initiation and subsequent modality choices. This systematic review... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Patient experiences and survival outcomes can be influenced by the circumstances related to dialysis initiation and subsequent modality choices. This systematic review and meta-analysis aimed to explore the rate and reasons for peritoneal dialysis (PD) dropout following haemodialysis (HD) to PD switch.
METHOD
This systematic review conducted searches in four databases, including Medline, PubMed, Embase, and Cochrane. The protocol was registered on PROSPERO (study ID: CRD42023405718). Outcomes included factors leading to the switch from HD to PD, the rate and reasons for PD dropout and mortality difference in two groups (PD first group versus HD to PD group). The Critical Appraisal Skills Programme (CASP) checklist and the GRADE tool were used to assess quality.
RESULTS
4971 papers were detected, and 13 studies were included. On meta-analysis, there was no statistically significant difference in PD dropout in the PD first group (OR: 0.81; 95%CI: 0.61, 1.09; I = 83%; P = 0.16), however, there was a statistically significant reduction in the rate of mortality (OR: 0.48; 95%CI: 0.25, 0.92; I2 = 73%; P = 0.03) compared to the HD to PD group. The primary reasons for HD to PD switch, included vascular access failure, patient preference, social issues, and cardiovascular disease. Causes for PD dropout differed between the two groups, but inadequate dialysis and peritonitis were the main reasons for PD dropout in both groups.
CONCLUSION
Compared to the PD first group, a previous HD history may not impact PD dropout rates for patients, but it could impact mortality in the HD to PD group. The reasons for PD dropout differed between the two groups, with no statistical differences. Psychosocial reasons for PD dropout are valuable to further research. Additionally, establishing a consensus on the definition of PD dropout is crucial for future studies.
Topics: Humans; Renal Dialysis; Peritoneal Dialysis; Cardiovascular Diseases; Peritonitis; Registries; Kidney Failure, Chronic
PubMed: 38493084
DOI: 10.1186/s12882-024-03542-w -
Blood Purification 2021The best timing of peritoneal dialysis (PD) initiation after catheter implantation is still controversial. It is necessary to explore whether there exists a waiting... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The best timing of peritoneal dialysis (PD) initiation after catheter implantation is still controversial. It is necessary to explore whether there exists a waiting period to minimize the risk of complications.
METHODS
A systematic review and meta-analysis were searched in multiple electronic databases published from inception to February 29, 2020, to identify cohort studies for evaluating the outcome and safety of unplanned-start PD (<14 days after catheter insertion). Risks of bias across studies were evaluated using Newcastle-Ottawa Quality Assessment Scale.
RESULTS
Fourteen cohort studies with a total of 2,401 patients were enrolled. We found that early-start PD was associated with higher prevalence of leaks (RR: 2.67, 95% CI, 1.55-4.61) and omental wrap (RR: 3.28, 95% CI, 1.14-9.39). Furthermore, patients of unplanned-start PD in APD group have higher risk of leaks, while those in CAPD group have a higher risk of leaks, omental wrap, and catheter malposition. In shorter break-in period (BI) group, the risk of suffering from catheter obstruction and malposition was higher for patients who started dialysis within 7 days after the surgery than for patients within 7-14 days. No significant differences were found in peritonitis (RR: 1.00; 95% CI, 0.78-1.27) and exit-site infections (RR: 1.12; 95% CI, 0.72-1.75). However, shorter BI was associated with higher risk of mortality and transition to hemodialysis (HD) while worsen early technical survival, with pooled RR of 2.14 (95% CI, 1.52-3.02), 1.42 (95% CI, 1.09-1.85) and 0.95 (95% CI, 0.92-0.99), respectively.
CONCLUSIONS
Evidence suggests that patients receiving unplanned-start PD may have higher risks of mechanical complications, transition to HD, and even mortality rate while worsening early technical survival, which may not be associated with infectious complications. Rigorous studies are required to be performed.
Topics: Catheterization; Humans; Infections; Peritoneal Dialysis; Peritonitis; Risk Assessment; Risk Factors
PubMed: 33120399
DOI: 10.1159/000510550 -
Annals of Gastroenterology 2022Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological gastrostomy (PRG) are invasive interventions used for enteral access. We performed a systematic...
BACKGROUND
Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological gastrostomy (PRG) are invasive interventions used for enteral access. We performed a systematic review and meta-analysis with assessment of certainty of evidence to compare the risk of adverse outcomes and technical failure between PEG and PRG.
METHODS
We queried PubMed, EMBASE, and Cochrane from inception through January 2022 to identify studies comparing outcomes of PEG and PRG. The primary outcome was 30-day all-cause mortality; secondary outcomes included the risk of colon perforation, peritonitis, bleeding, technical failure, peristomal infections, and tube-related complications. We performed GRADE assessment to assess the certainty of evidence and leave-one-out analysis for sensitivity analysis.
RESULTS
In the final analysis, 33 studies, including 26 high-quality studies, provided data on 275,117 patients undergoing PEG and 192,691 patients undergoing PRG. Data from high quality studies demonstrated that, compared to PRG, PEG had significantly lower odds of selected outcomes, including 30-day all-cause mortality (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.60-0.95; P=0.02), colon perforation (OR 0.61, 95%CI 0.49-0.75; P<0.001), and peritonitis (OR 0.71, 95%CI 0.63-0.81; P<0.001). There was no significant difference between PEG and PRG in terms of technical failure, bleeding, peristomal infections or mechanical complications. The certainty of the evidence was rated moderate for colon perforation and low for all other outcomes.
CONCLUSIONS
PEG is associated with a significantly lower risk of 30-day all-cause mortality, colon perforation, and peritonitis compared to PRG, while having a comparable technical failure rate. PEG should be considered as the first-line technique for enteral access.
PubMed: 36406969
DOI: 10.20524/aog.2022.0752 -
Therapeutic Advances in... 2022Percutaneous cecostomy is a minimally invasive procedure that provides access to the colon for therapeutic interventions. This review aimed to update and summarize the... (Review)
Review
OBJECTIVE
Percutaneous cecostomy is a minimally invasive procedure that provides access to the colon for therapeutic interventions. This review aimed to update and summarize the existing information on the use and application of percutaneous endoscopic cecostomy in the field of therapeutic gastroenterology.
DATA SOURCES
A systematic review of the literature was performed without any restrictions on the year of publication from the date of inception in 1986 to January 2021.
METHODS
The review was performed using the medical subject heading keywords in the following search engines: MEDLINE, EMBASE, Cochrane, and Google Scholar.
RESULTS
A total of 29 articles were subjected to final data extraction. The review included a total of 174 patients who underwent percutaneous cecostomy. Most of the included studies were conducted in the United States ( = 14). The most common comorbidity was cancer ( = 10) and the major indication for performing percutaneous cecostomy was colonic pseudo-obstruction or Ogilvie's syndrome ( = 15). The main technique for performing percutaneous cecostomy was endoscopy (17 studies), followed by fluoroscopy- (five studies), computed-tomography- (three studies), laparoscopy- (two studies), and ultrasound- (one study) guided procedures. The procedure was technically successful in 153 (88%) cases. The total cumulative rates of major and minor complications were 47.5%. These complications included tube malfunction, local wound site infections, and bleeding and rare complications of peritonitis and death.
CONCLUSION
Percutaneous cecostomy is a safe and effective option for managing acute colonic pseudo-obstruction. It leads to durable symptom relief with low to minimal risk.
PubMed: 35141521
DOI: 10.1177/26317745211073411 -
Clinical Spine Surgery Aug 2020Systematic review and meta-analysis. (Comparative Study)
Comparative Study Meta-Analysis
A Comparison of Complications and Clinical and Radiologic Outcome Between the Mini-open Prepsoas and Mini-open Transpsoas Approaches for Lumbar Interbody Fusion: A Meta-Analysis.
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
To compare complication rates and clinical and radiologic outcome between the mini-open prepsoas and mini-open transpsoas approaches for lateral lumbar interbody fusion.
SUMMARY OF BACKGROUND DATA
Both approaches are believed to be safe with similar complication rates. Previous studies suggest that the rate of neurological injury might be higher in the transpsoas group, whereas visceral or vascular injury might be more frequent in the prepsoas group.
METHODS
A systematic review of the literature was performed. Data were extracted from original publications up until December 26, 2018. Evidence was extracted from well-designed case-control or cohort studies and sorted in 2 groups, the prepsoas and transpsoas approaches. A meta-analysis was performed using a random-effects model (I statistic >50% for all analyses).
RESULTS
A total of 115 studies included data of 13,260 patients, 2450 in the prepsoas group and 10,810 in the transpsoas group. Demographics for prepsoas versus transpsoas group were (N-weighted means): age 61.9 versus 60.9 years; %female sex 53% versus 63%, levels fused 1.4 versus 2.6, blood loss 52.4 versus 122.3 mL, and operating time 125.1 versus 200.7 min. The following statistically significant differences in complication rates between prepsoas and transpsoas approaches were found: transient psoas weakness or thigh/groin numbness 4% versus 26% [95% confidence interval (CI): 11%-17%], motor neural injury 0.4% versus 1.3% (95% CI: 16%-62.3%); no statistically significant differences were found for: major vascular injury 2% versus 1% (95% CI: 1.04%-2.31%), kidney or ureter injury 0.04% versus 0.08% (95% CI: 0.057%-5.2%), injury pleural/peritoneal structures 0.6% versus 0.2% (95% CI: 0.89%-6.58%), cage subsidence 5% versus 4% (95% CI: 0.9%-1.97%), surgical site infection 1% versus 1% (95% CI: 0.57%-1.66%), abdominal wall pseudohernia 1% versus 1% (95% CI: 0.07%-21.22%), sympathetic chain injury 5% versus 0% (95% CI: 0.34%-97.86%), and directly procedure-related death 0.04% versus 0% (95% CI: 0.127%-76.8%). Pooled mean perioperative changes between prepsoas and transpsoas approaches were: segmental sagittal Cobb angle 3.07 versus 1.99 degrees; foraminal height 2 versus 6.96 mm.
CONCLUSIONS
The prepsoas had fewer complications than the transpsoas approach. Furthermore, the prepsoas approach showed superior restoration of segmental lordosis, whereas foraminal height restoration was superior with the transpsoas approach. This could be explained by the differences in location of the interbody device placement in relation to the center of rotation of the spine between the 2 surgical techniques.
Topics: Humans; Intervertebral Disc Degeneration; Lumbar Vertebrae; Operative Time; Postoperative Complications; Psoas Muscles; Spinal Fusion
PubMed: 32482972
DOI: 10.1097/BSD.0000000000001015 -
International Journal of Colorectal... Aug 2021The aim of this study was to compare the outcomes of right hemicolectomy with CME performed with laparoscopic and open surgery. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The aim of this study was to compare the outcomes of right hemicolectomy with CME performed with laparoscopic and open surgery.
METHODS
PubMed, Scopus, Web of Science, China National Knowledge Infrastructure, Wanfang Data, Google Scholar and the ClinicalTrials.gov register were searched. Primary outcome was the overall number of harvested lymph nodes. Secondary outcomes were short and long-term course variables. A meta-analysis was performed to calculate risk ratios.
RESULTS
Twenty-one studies were identified with 5038 patients enrolled. The difference in number of harvested lymph nodes was not statistically significant (MD 0.68, - 0.41-1.76, P = 0.22). The only RCT shows a significant advantage in favour of laparoscopy (MD 3.30, 95% CI - 0.20-6.40, P = 0.04). The analysis of CCTs showed an advantage in favour of the laparoscopic group, but the result was not statically significantly (MD - 0.55, 95% CI - 0.57-1.67, P = 0.33). The overall incidence of local recurrence was not different between the groups, while systemic recurrence at 5 years was lower in laparoscopic group. Laparoscopy showed better short-term outcomes including overall complications, lower estimated blood loss, lower wound infections and shorter hospital stay, despite a longer operative time. The rate of anastomotic and chyle leak was similar in the two groups.
CONCLUSIONS
Despite the several limitations of this study, we found that the median number of lymph node harvested in the laparoscopic group is not different compared to open surgery. Laparoscopy was associated with a lower incidence of systemic recurrence.
Topics: China; Colectomy; Colonic Neoplasms; Humans; Laparoscopy; Length of Stay; Lymph Node Excision; Mesocolon; Neoplasm Recurrence, Local; Operative Time; Treatment Outcome
PubMed: 33644837
DOI: 10.1007/s00384-021-03891-0 -
Cancer Metastasis Reviews Mar 2023Pseudomyxoma peritonei (PMP) is a rare, progressive, slowly growing neoplastic condition which is poorly understood, with a 5-year progression-free survival rate as low... (Review)
Review
Pseudomyxoma peritonei (PMP) is a rare, progressive, slowly growing neoplastic condition which is poorly understood, with a 5-year progression-free survival rate as low as 48%. PMP is most commonly caused by appendiceal mucinous neoplasms (AMN), and understanding their genetic biology and pathogenicity may allow for the development of better novel systemic treatments to target key deleterious mutations and the implicated pathways. The primary aim of this systematic review was to identify the genetic profile of histologically confirmed human PMP or AMN samples. The secondary aim was to identify whether genetic marks could be used to predict patient survival. Ovid EMBASE, Ovid MEDLINE, PubMed, and Web of Science were searched to identify studies investigating the genetic profile of histologically-confirmed human PMP or AMN samples. We review findings of 46 studies totalling 2181 tumour samples. The most frequently identified somatic gene mutations in patients with PMP included KRAS (38-100%), GNAS (17-100%), and TP53 (5-23%); however, there were conflicting results of their effect on survival. Three studies identified molecular subtypes based on gene expression profiles classifying patients into oncogene-enriched, immune-enriched, and mixed molecular subtypes with prognostic value. This review summarises the current literature surrounding genetic aberrations in PMP and AMNs and their potential utility for targeted therapy. Given the recent advances in clinical trials to directly target KRAS and GNAS mutations in other cancers, we propose a rationale to explore these mutations in future pre-clinical studies in PMP with a view for a future clinical trial.
Topics: Humans; Pseudomyxoma Peritonei; Peritoneal Neoplasms; Appendiceal Neoplasms; Genetic Profile; Proto-Oncogene Proteins p21(ras)
PubMed: 36723696
DOI: 10.1007/s10555-023-10088-0 -
The Journal of Antimicrobial... Sep 2022Trichoderma spp. are filamentous fungi causing invasive fungal diseases in patients with haematological malignancies and in peritoneal dialysis patients.
BACKGROUND
Trichoderma spp. are filamentous fungi causing invasive fungal diseases in patients with haematological malignancies and in peritoneal dialysis patients.
OBJECTIVES
To analyse clinical presentation, predisposing factors, treatment and outcome of Trichoderma infections.
METHODS
A systematic literature review was conducted for published cases of invasive Trichoderma infection in PubMed until December 2021 and by reviewing the included studies' references. Cases from the FungiScope® registry were added to a combined analysis.
RESULTS
We identified 50 invasive infections due to Trichoderma species, including 11 in the FungiScope® registry. The main underlying conditions were haematological malignancies in 19 and continuous ambulatory peritoneal dialysis (CAPD) in 10 cases. The most prevalent infection sites were lung (42%) and peritoneum (22%). Systemic antifungal therapy was administered in 42 cases (84%), mostly amphotericin B (n = 27, lipid-based formulation 13/27) and voriconazole in 15 cases (30%). Surgical interventions were performed in 13 cases (26%). Overall mortality was 48% (n = 24) and highest for allogeneic HSCT and solid organ transplantation (SOT) recipients [80% (4/5) and 77% (7/9), respectively]. In patients treated with amphotericin B, voriconazole and caspofungin, mortality was 55% (15/27), 46% (7/15) and 28% (2/7), respectively. Three out of four patients treated with a combination therapy of voriconazole and caspofungin survived.
CONCLUSIONS
Despite treatment with antifungal therapies and surgery, invasive Trichoderma infections are life-threatening complications in immunocompromised patients, especially after HSCT and SOT. In addition, Trichoderma spp. mainly affect the lungs in patients with haematological malignancies and the peritoneum in CAPD patients.
Topics: Amphotericin B; Antifungal Agents; Caspofungin; Hematologic Neoplasms; Humans; Registries; Trichoderma; Voriconazole
PubMed: 35929089
DOI: 10.1093/jac/dkac235