Peritoneal Dialysis Guidelines 2019 Part 2: Main Text (Position paper of the Japanese Society for Dialysis Therapy)

Ryuzaki, Munekazu; Ito, Yasuhiko; Nakamoto, Hidetomo; Ishikawa, Yuichi; Itami, Noritomo; Ito, Minoru; Ueda, Atsushi; Kanazawa, Yoshie; Kawanishi, Hideki; Kanno, Yoshihiko; Sugiyama, Hitoshi; Tsuruya, Kazuhiko; Terawaki, Hiroyuki; Tomo, Tadashi; Fukasawa, Mizuya; Yamashita, Akihiro C.; Yokoi, Hideki; Nakayama, Masaaki; Yuasa, Hidemichi; Tsujimoto, Yasushi; Tsujimoto, Hiraku; Saka, Yosuke; Kuroki, Yusuke; Yasuda, Kaoru; Fujii, Takayuki; Kanno, Atsuhiro; Fujikura, Emi; Watanabe, Kimio; Obata, Yoko; Murashima, Miho; Toda, Naohiro; Yamamoto, Shuto; Tsujimoto, Yoshihiro; Sakurada, Tsutomu; Komukai, Daisuke; Uchiyama, Kiyotaka; Washida, Naoki; Morimoto, Kohkichi; Kasai, Takahiro; Maruyama, Yukio; Higuchi, Chieko; Io, Hiroaki; Wakabayashi, Keiichi

doi:10.1186/s41100-021-00361-9

Table 3 Evidence profile: SR1.1. Comparison of ACEI and ARB with other drugs

From: Peritoneal Dialysis Guidelines 2019 Part 2: Main Text (Position paper of the Japanese Society for Dialysis Therapy)

Certainty assessment							Number of patients		Effect		Certainty	Importance
No. of studies	Study design	Bias risk	Inconsistency	Indirectness	Inaccuracy	Other	ARB, ACEI	Other drugs	Relative [95% CI]	Absolute (95% CI)
Overall survival rate (number of deaths due to events)
6	RCT	Serious ^a	Not serious	Not serious	Serious ^b	None	3/135 (2.2%)	2/104 (1.9%)	Cannot estimate	No change per 1000 patients (40 patients decreased to 50 patients increased)	⨁⨁◯◯ Low	Critical
Technical survival (PD continuation period, PD withdrawal) (PD withdrawal)
6	RCT	Serious ^c	Not serious	Not serious	Serious ^d	None	3/134 (2.2%)	3/104 (2.9%)	Cannot estimate	No change per 1000 patients (50 patients decreased to 40 patients increased)	⨁⨁◯◯ Low	Critical
Technical survival (PD continuation period/PD withdrawal) (peritonitis)
2	RCT	Not serious	Not serious	Serious ^e	Serious ^f	None	12/48 (25.0%)	12/46 (26.1%)	RR 0.98 [0.49–1.95]	5 patients decreased per 1000 patients (248 patients decreased to 133 patients increased)	⨁⨁◯◯ Low	Important
Urine volume/residual renal function (urine volume)
6	RCT	Serious ^c	Not serious	Not serious	Serious ^g	None	105	89	-	MD 142.56 mL increase (25.42 mL increase to 259.69 mL increase)	⨁⨁◯◯ Low	Critical
Urine volume/residual renal function (anuria)
3	RCT	Serious ^c	Not serious	Not serious	Serious ^h	None	23/67 (34.3%)	29/59 (49.2%)	RR 0.70 [0.48–1.02]	147 patients decreased per 1000 patients (256 patients decreased to 10 patients increased)	⨁⨁◯◯ Low	Critical
Urine volume/residual renal function (GFR)
4	RCT	Serious ⁱ	Not serious	Not serious	Serious ^j	None	87	76	-	MD 0.97 increase (0.49 decrease to 1.44 increase)	⨁⨁◯◯ Low	Critical
Dialysis volume (total Kt/V)
3	RCT	Serious ^c	Not serious	Serious ^k	Serious ^l	None	61	49	-	MD 0.21 increase (0.04 decrease to- 0.46 increase)	⨁◯◯◯ Very low	Important
Complications (including drug adverse effects/safety issues/hospital stay period) (hyperkalemia)
1	RCT	Serious ^c	Not serious	Not serious	Serious ^{m, n}	None	0/30 (0.0%)	0/15 (0.0%)	Cannot estimate	No change per 1000 patients (100 patients decreased to 100 patients increased)	⨁⨁◯◯ Low	Important
Complications (including drug adverse effects/safety issues/hospital stay period) (hospitalization)
1	RCT	Not serious	Not serious	Serious ^o	Serious ^p	None	14/30 (46.7%)	13/30 (43.3%)	Cannot estimate	30 patients decreased per 1000 patients (280 patients decreased to 220 patients increased)	⨁⨁◯◯ Low	Important
Other outcomes deemed important by the CQ team (cardiovascular events)
2	RCT	Not serious	Not serious	Not serious	Serious ^q	None	5/48 (10.4%)	5/46 (10.9%)	Cannot estimate	No change per 1000 patients (90 patients decreased to 90 patients increased)	⨁⨁⨁◯ Moderate	Critical

CI, confidence interval; RR, risk ratio; MD, mean difference; RCT, randomized clinical trial
^aMany unclear elements. About half of the included studies are at high risk of having incomplete outcome data
^bIf considering 1% of risk difference as the clinical decision threshold, the 95% CI of risk difference crosses the threshold
^cThere is an unignorable bias in the studies with high weight
^dIf considering 2% of risk difference in PD technical failure as the clinical decision threshold, the 95% CI of risk difference crosses the threshold
^eDue to the definition of peritonitis as a cause of technical survival
^fIf considering 2% of risk difference in the PD peritonitis rate as the clinical decision threshold, the 95% CI of risk difference crosses the threshold
^gIf considering 100 ml of urine volume difference as the clinical decision threshold, the 95% CI of mean difference crosses the threshold
^hIf considering 5% of risk difference in the anuria rate as the clinical decision threshold, the 95% CI of risk difference crosses the threshold
ⁱThere are unignorable biases in allocation concealment and incomplete data in two studies
^jIf considering 1.0 ml/min of GFR difference as the clinical decision threshold, the 95% CI of mean difference crosses the threshold
^kTotal Kt/V is the sum of residual renal and peritoneal urea clearance and therefore does not indicate peritoneal membrane function
^lIf considering 0.1 of a total Kt/N difference as the clinical decision threshold, the 95% CI of mean difference crosses the threshold
^mThe low number of events
ⁿIf considering 5% of risk difference in hyperkalemia as the clinical decision threshold, the 95% CI of risk difference crosses the threshold
^oDue to the definition of hospitalization as a complication
^pIf considering 2% of risk difference in the hospitalization rate as the clinical decision threshold, the 95% CI of risk difference crosses the threshold
^qIf considering 2% of risk difference in cardiovascular events as the clinical decision threshold, the 95% CI of risk difference crosses the threshold

Back to article page

ISSN: 2059-1381

Contact us

Submission enquiries: Access here and click Contact Us
General enquiries: info@biomedcentral.com

Renal Replacement Therapy

Contact us