title: Comparison of life participation activities among adults treated by hemodialysis, peritoneal dialysis, and kidney transplantation: a systematic review.
abstract: BACKGROUND
  A comprehensive assessment of the association of patients' renal replacement therapy (RRT) modality with their participation in life activities (physical function, travel, recreation, freedom, and work) is needed.
  
  
  METHODS
  Systematic review of peer-reviewed published studies.
  
  
  METHODS
  Adults undergoing RRT (hemodialysis, peritoneal dialysis, or transplantation).
  
  
  METHODS
  We searched PubMed, Cochrane Library, and EMBASE from January 1980 through April 2012 for English-language articles that compared participation in life activities among patients receiving: (1) hemodialysis compared with peritoneal dialysis, (2) hemodialysis compared with kidney transplantation, or (3) peritoneal dialysis compared with kidney transplantation.
  
  
  METHODS
  RRT modality.
  
  
  RESULTS
  Reported rates of physical function, travel, recreation, freedom, and work-related activities by RRT modality.
  
  
  RESULTS
  46 studies (6 prospective cohort, 38 cross-sectional, and 2 pre-post transplantation) provided relevant comparisons of life participation activities among patients treated with hemodialysis, peritoneal dialysis, and kidney transplantation. Studies were conducted in 1985-2011 among diverse patient populations in 16 distinct locations. A majority of studies reported greater life participation rates for patients with kidney transplants compared with patients receiving either hemodialysis or peritoneal dialysis. In contrast, a majority of studies reported no differences in outcomes between patients receiving hemodialysis and patients receiving peritoneal dialysis. These results were consistent throughout the study period, across diverse populations, and among the subset of studies that performed appropriate adjustments for potential confounding factors.
  
  
  CONCLUSIONS
  Many studies included in the review had significant design weaknesses.
  
  
  CONCLUSIONS
  Evidence suggests that patients with kidney transplants may experience better rates of life participation compared with patients receiving dialysis, whereas patients receiving hemodialysis and patients receiving peritoneal dialysis may experience similar rates of life participation. Rigorously performed studies are needed to better inform patients about the association of RRT with these important patient-reported outcomes.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD. Electronic address: tpurnel1@jhmi.edu.
authors.forename: Tanjala S
authors.initials: TS
authors.lastname: Purnell
authors.forename: Priscilla
authors.initials: P
authors.lastname: Auguste
authors.forename: Deidra C
authors.initials: DC
authors.lastname: Crews
authors.forename: Julio
authors.initials: J
authors.lastname: Lamprea-Montealegre
authors.forename: Temitope
authors.initials: T
authors.lastname: Olufade
authors.forename: Raquel
authors.initials: R
authors.lastname: Greer
authors.forename: Patti
authors.initials: P
authors.lastname: Ephraim
authors.forename: Johanna
authors.initials: J
authors.lastname: Sheu
authors.forename: Daniel
authors.initials: D
authors.lastname: Kostecki
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.forename: Hamid
authors.initials: H
authors.lastname: Rabb
authors.forename: Bernard
authors.initials: B
authors.lastname: Jaar
authors.forename: L Ebony
authors.initials: LE
authors.lastname: Boulware
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010530:Peritoneal Dialysis; D011788:Quality of Life / Q000523:psychology*; D006435:Renal Dialysis; D017582:Renal Replacement Therapy; D058992:Social Participation / Q000523:psychology*; D016896:Treatment Outcome
keywords: Dialysis; end-stage renal disease (ESRD) treatment; kidney transplantation; physical functioning; quality of life; social participation