title: Dialysis modality choice in diabetic patients with end-stage kidney disease: a systematic review of the available evidence.
abstract: BACKGROUND
  Diabetes is the leading cause of end-stage kidney disease (ESKD). Because of conflicting results in observational studies, it is still subject to debate whether in diabetic patients the dialysis modality selected as first treatment (haemodialysis or peritoneal dialysis) may have a major impact on outcomes. We therefore aimed at performing a systematic review of the available evidence.
  
  
  METHODS
  MEDLINE, EMBASE and CENTRAL databases were searched until February 2014 for English-language articles without time or methodology restrictions by highly sensitive search strategies focused on diabetes, end-stage kidney disease and dialysis modality. Selection of relevant studies, data extraction and analysis were performed by two independent reviewers.
  
  
  RESULTS
  Twenty-five observational studies (23 on incident and 2 on prevalent cohorts) were included in this review. Mortality was the only main outcome addressed in large cohorts. When considering patient survival, results were inconsistent and varied across study designs, follow-up period and subgroups. We therefore found no evidence-based arguments in favour or against a particular dialysis modality as first choice treatment in patients with diabetes and ESKD. However, peritoneal dialysis (PD) as first choice seems to convey a higher risk of death in elderly and frail patients.
  
  
  CONCLUSIONS
  The available evidence derived from observational studies is inconsistent. Therefore evidence-based arguments indicating that HD or PD as first treatment may improve patient-centred outcomes in diabetics with ESKD are lacking. In the absence of such evidence, modality selection should be governed by patient preference, after unbiased patient information.
authors.affiliation: REIN registry, Agence de la biomédecine, Saint-Denis La Plaine, France.
authors.forename: Cecile
authors.initials: C
authors.lastname: Couchoud
authors.affiliation: CNR-Institute of Clinical Physiology, Reggio Calabria, Italy ERBP, Ghent University Hospital, Ghent, Belgium.
authors.forename: Davide
authors.initials: D
authors.lastname: Bolignano
authors.affiliation: Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
authors.forename: Ionut
authors.initials: I
authors.lastname: Nistor
authors.affiliation: ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
authors.affiliation: Department of Nephrology B, Copenhagen University hospital at Herlev, Herlev, Denmark.
authors.forename: James
authors.initials: J
authors.lastname: Heaf
authors.affiliation: Division of Renal Medicine, Department of Clinical Science, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Heimburger
authors.affiliation: Chair of ERBP, Renal Division, Ghent University Hospital, Ghent, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Van Biesen
mesh_terms: D002755:Choice Behavior; D048909:Diabetes Complications; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010530:Peritoneal Dialysis; D006435:Renal Dialysis
keywords: diabetes; epidemiology; haemodialysis; peritoneal dialysis; systematic review