Song Kai, Jiang Shan, Shi Yongbing, Shen Huaying, Shi Xiaosong, Jing Donghua
Department of Nephrology, Second Affiliated Hospital of Soochow University, Suzhou, China.
Am J Nephrol. 2010;32(5):497-504. doi: 10.1159/000321344. Epub 2010 Oct 26.
Contrast-induced acute kidney injury (CI-AKI) is an important cause of acute renal injury. Several clinical trials using renal replacement therapy (RRT) for prevention of CI-AKI yielded conflicting results. We performed a meta-analysis to assess the efficacy of prophylactic RRT on CI-AKI.
Randomized controlled trials on CI-AKI using RRT were identified without language restriction in Cochrane library, Pubmed and Embase. Data extracted from literature were analyzed with Review manager and Stata software.
Nine randomized controlled trials involving 751 patients were included. Heterogeneity was found across trials (p < 0.00001). A random effect model was used to combine the data. RRT reduced the risk of CI-AKI by 26% compared with the control group, but statistical significance was not reached (risk ratio (RR) 0.74, 95% CI 0.35-1.60, p = 0.45). Subgroup analysis of modality indicated that hemodialysis was ineffective in reducing the risk of CI-AKI (RR 1.21, 95% CI 0.63-2.32, p = 0.57), while CRRT decreased the incidence of CI-AKI (RR 0.22, 95% CI 0.07-0.64, p = 0.006). Subgroup analysis according to the CKD stage did not record heterogeneity across trials. RRT increased the odds of CI-AKI in CKD stage 3 patients (RR 1.53, 95% CI 0.07-0.64, p = 0.01), but decreased the occurrence of CI-AKI in patients with CKD stage higher than 3 (RR 0.74, 95% CI 0.35-1.60, p = 0.45). The pooled RR of the need for permanent dialysis demonstrated an insignificant trend towards benefit in patients treated with RRT (RR 0.61, 95% CI 0.26-1.40, p = 0.24). RRT reduced in-hospital mortality compared with control group (RR 0.33, 95% CI 0.14-0.77, p = 0.01).
RRT fails to reduce the incidence of CI-AKI in CKD stage 3 patients, but may be beneficial in patients with more advanced renal function. CRRT is more effective than hemodialysis for prevention of CI-AKI. RRT is effective in reducing the in-hospital mortality of CI-AKI patients.
对比剂诱导的急性肾损伤（CI-AKI）是急性肾损伤的重要原因。多项使用肾脏替代治疗（RRT）预防CI-AKI的临床试验结果相互矛盾。我们进行了一项荟萃分析以评估预防性RRT对CI-AKI的疗效。
在Cochrane图书馆、Pubmed和Embase中检索关于使用RRT治疗CI-AKI的随机对照试验，无语言限制。从文献中提取的数据使用Review manager和Stata软件进行分析。
纳入9项涉及751例患者的随机对照试验。各试验间存在异质性（p<0.00001）。采用随机效应模型合并数据。与对照组相比，RRT使CI-AKI风险降低了26%，但未达到统计学显著性（风险比（RR）0.74，95%置信区间0.35 - 1.60，p = 0.45）。治疗方式亚组分析表明，血液透析在降低CI-AKI风险方面无效（RR 1.21，95%置信区间0.63 - 2.32，p = 0.57），而连续性肾脏替代治疗（CRRT）降低了CI-AKI的发生率（RR 0.22，95%置信区间0.07 - 0.64，p = 0.006）。根据慢性肾脏病（CKD）分期进行的亚组分析未发现各试验间存在异质性。RRT增加了CKD 3期患者发生CI-AKI的几率（RR 1.53，95%置信区间0.07 - 0.64，p = 0.01），但降低了CKD 3期以上患者CI-AKI的发生几率（RR 0.74，95%置信区间0.35 - 1.60，p = 0.45）。关于需要长期透析的合并RR显示，接受RRT治疗的患者有获益趋势，但不显著（RR 0.61，95%置信区间0.26 - 1.40，p = 0.24）。与对照组相比，RRT降低了住院死亡率（RR 0.33，95%置信区间0.14 - 0.77，p = 0.01）。
RRT未能降低CKD 3期患者CI-AKI的发生率，但可能对肾功能更差的患者有益。CRRT在预防CI-AKI方面比血液透析更有效。RRT可有效降低CI-AKI患者的住院死亡率。
