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Difference in the risk of gastrointestinal signs and symptoms between peritoneal and hemodialysis patients: a systematic review and meta-analysis

gastroenterology-and-hepatology

Abstract

Objective: A large number of patients on dialysis have gastrointestinal (GI) signs and symptoms. However, it remains unclear if dialysis modality has an impact on their prevalence. We present the first systematic review and meta-analysis of literature comparing the risk of GI signs and symptoms between hemodialysis (HD) and peritoneal dialysis (PD).

Methods: Comparative studies were searched on Embase, PubMed, and Scopus from January 1, 2000, to April 1, 2025. Any GI signs and symptoms reported by at least two studies were quantitatively analyzed to obtain the odds ratio (OR) in a random-effect meta-analysis model.

Results: 12 studies were included. Pooled analysis of four studies showed no statistically significant difference in the presence of any GI signs or symptoms between HD and PD. Moreover, the meta-analysis also showed that there were no significant differences between the two groups for abdominal pain, anorexia, constipation, diarrhea, duodenal ulcer, dyspepsia, dysphagia, epigastric pain, esophagitis, gastritis, heartburn, inflammatory bowel disease, nausea, vomiting, pancreatitis, and GI polyps. The risk of cirrhosis, GI bleeding, and gastric ulcer was significantly higher in HD, while the risk of gastroesophageal reflux disease was significantly increased in patients on PD.

Conclusions: Present evidence suggests that the majority of GI signs or symptoms do not differ between HD and PD patients. It seems that the risk of cirrhosis, GI bleeding, and gastric ulcer is increased in HD, while the risk of gastroesophageal reflux disease is increased in PD. Further studies can aid in increasing the strength and quality of evidence.

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