Jiang Lei, Zeng Rong, Yang Kehu, Mi Deng Hai, Tian Jin Hui, Ma Bin, Liu Yali
Evidence-BasedMedicine Center, School of BasicMedical Sciences, Lanzhou University, Lanzhou City,
Cochrane Database Syst Rev. 2012 Jun 13(6):CD007016. doi: 10.1002/14651858.CD007016.pub2.
Acute kidney injury (AKI) is associated with substantial morbidity and mortality. Recent studies have shown that dialysis dose was a major factor associated with patient survival. Unresolved questions persist about which mode of peritoneal dialysis (PD) should be used for most patients with AKI.
To assess the benefits and harms of tidal PD (TPD) versus other forms of PD on outcomes for patients with AKI.
In February 2012 we searched the Cochrane Renal Group's specialised register, CENTRAL (in The Cochrane Library), MEDLINE (from 1966) and EMBASE (from 1980). We also searched reference lists of included studies, review articles and nephrology text books, and contacted local and international experts.
All randomised controlled trials (RCTs) and quasi-RCTs (RCTs in which allocation to treatment was obtained by alternation, use of alternate medical records, date of birth or other predictable methods) of TPD versus other forms of PD for AKI.
Two authors independently reviewed search results, extracted data and assessed risk of bias. Results were expressed as risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) for continuous outcomes using a random-effects model.
We included one randomised cross-over study, enrolling 87 participants, which compared TPD with continuous equilibrating PD (CEPD) for patients with AKI. Sequence generation was adequate while allocation concealment was not reported. Our primary outcomes of mortality and recovery of renal function (complete or partial) were not reported (high risk of selective reporting bias). The results from this one study showed TPD resulted in higher creatinine clearance (CrCl) (MD 1.88 mL/min, 95% CI 0.91 to 2.85) and blood urea nitrogen (BUN) clearance (MD 14.71 mL/min, 95% CI 8.24 to 21.18) than CEPD; was superior to CEPD in the removal of potassium, phosphates and in generating ultrafiltrate; was better tolerated; consumed less time and was less expensive than CEPD. There was greater protein loss with TPD. No adverse events were reported.
AUTHORS' CONCLUSIONS: At present, there is insufficient RCT evidence to enable evaluation of the effect of TPD in patients with AKI. Well-designed and larger RCTs are required to better understand the risks and benefits of TPD for AKI.
急性肾损伤（AKI）与高发病率和死亡率相关。近期研究表明，透析剂量是与患者生存相关的主要因素。对于大多数AKI患者应采用哪种腹膜透析（PD）模式，仍存在未解决的问题。
评估潮式腹膜透析（TPD）与其他形式的PD相比，对AKI患者预后的利弊。
2012年2月，我们检索了Cochrane肾脏组的专业注册库、CENTRAL（Cochrane图书馆）、MEDLINE（自1966年起）和EMBASE（自1980年起）。我们还检索了纳入研究的参考文献列表、综述文章和肾脏病学教科书，并联系了国内外专家。
所有关于TPD与其他形式的PD治疗AKI的随机对照试验（RCT）和半随机对照试验（通过交替、使用交替病历、出生日期或其他可预测方法进行治疗分配的RCT）。
两位作者独立审查检索结果、提取数据并评估偏倚风险。结果以风险比（RR）表示，二分变量结局的95%置信区间（CI），连续变量结局采用随机效应模型表示为平均差（MD）。
我们纳入了一项随机交叉研究，招募了87名参与者，该研究比较了TPD与持续性非卧床腹膜透析（CAPD）治疗AKI患者的效果。序列生成恰当，但未报告分配隐藏情况。我们未报告死亡率和肾功能恢复（完全或部分恢复）的主要结局（存在高度选择性报告偏倚风险）。这项研究的结果表明，TPD导致的肌酐清除率（CrCl）（MD 1.88 mL/min，95%CI 0.91至2.85）和血尿素氮（BUN）清除率（MD 14.71 mL/min，95%CI 8.24至21.18）高于CAPD；在清除钾、磷酸盐和产生超滤方面优于CAPD；耐受性更好；比CAPD耗时更少且成本更低。TPD导致的蛋白质丢失更多。未报告不良事件。
目前，尚无足够的RCT证据来评估TPD对AKI患者的疗效。需要设计更完善、规模更大的RCT，以更好地了解TPD治疗AKI的风险和益处。
