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

Objective: A large number of patients on dialysis have gastrointestinal (GI) manifestations. However, it remains unclear whether dialysis modality affects their prevalence. We present the first systematic review and meta-analysis of literature comparing the risk of GI manifestations 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 manifestation reported by at least two studies were quantitatively analysed to obtain the odds ratio (OR) in a random-effect meta-analysis model. Results: A total of 12 studies were included. Pooled analysis of four studies showed no statistically significant difference in the presence of any GI manifestation between HD and PD. Moreover, the meta-analysis showed no significant differences between the two groups for abdominal pain, anorexia, constipation, diarrhoea, duodenal ulcer, dyspepsia, dysphagia, epigastric pain, esophagitis, gastritis, heartburn, inflammatory bowel disease, nausea, vomiting, pancreatitis, and GI polyps. The risk of cirrhosis, pancreatitis, 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 from a small number of observational studies suggests that majority of GI signs or symptoms do not differ between HD and patients receiving PD. The risk of cirrhosis, pancreatitis, GI bleeding, and gastric ulcer appears higher in HD, whereas the likelihood of gastroesophageal reflux disease is elevated in PD. Observed differences between HD and PD should be interpreted cautiously, as they may partly reflect differences in patient selection, comorbidity profiles, and care pathways rather than a direct causal effect of dialysis modality. Further research can strengthen the quality of the evidence.