Peritoneal dialysis versus hemodialysis in Latin America: systematic review and meta-analysis of observational studies (2010–2024)

Tamara Bórquez-Villagra, Presidencia, Sociedad Chilena de Nefrología (Sochinefro), Santiago de Chile, Chile
Rina Morales, Programa de Diálisis Peritoneal, Senferdial, Santiago de Chile, Chile
Ana Mireya-Ortiz, Facultad de medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
Isabel Saravia, Departamento Médico, Vantive, Bogotá D.C., Colombia
Jorge Ospina, Departamento de epidemiología, Epithink Health Consulting, Bogotá, Colombia

Objective: To evaluate Latin American evidence comparing peritoneal dialysis (PD) and hemodialysis (HD) regarding clinical outcomes, costs, and quality of life. Material and methods: Systematic review following PRISMA 2020. Observational studies and clinical trials published from 2010 to 2024 were included if they compared adult patients with CKD stage 5 treated with PD or HD in Latin America. All-cause mortality, technique survival, hospitalizations, infectious complications, costs, and quality of life were evaluated. Meta-analysis used random-effects models (Hartung-Knapp). Certainty was graded using GRADE. Results: From 97 records, 25 studies were included. Three cohorts (n = 44,337) reported adjusted hazard ratios for mortality, with a pooled estimate of 0.95 (95%CI: 0.70–1.29; p = 0.55), showing no significant difference between modalities. PD was associated with higher hospitalization rates due to peritonitis, although telemonitoring programs reduced this burden. Vascular access infections were more common in HD. Economic analyses from Peru, Mexico, Brazil, and Colombia favored PD due to lower annual costs. Evidence on quality of life was heterogeneous and of low certainty. Conclusions: In Latin America, PD is a clinically comparable but economically advantageous alternative to HD, with specific infectious risks that can be mitigated by structured educational and monitoring programs. The certainty of evidence is low, highlighting the need for prospective multicenter research.

Keywords: Peritoneal dialysis. Hemodialysis. Renal replacement therapy. Mortality. Systematic review.