Tian Jin Hui, Ma Bin, Yang KeHu, Liu Yali, Tan Jiying, Liu Tian Xi
Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199, Donggang West Road, Lanzhou City, Gansu, China, 730000.
Cochrane Database Syst Rev. 2015 Mar 5;2015(3):CD006819. doi: 10.1002/14651858.CD006819.pub2.
Acute kidney injury (AKI) is a severe loss of kidney function that results in patients' inability to appropriately excrete nitrogenous wastes and creatinine. Continuous haemodiafiltration (HDF) or haemofiltration (HF) are commonly used renal replacement therapies for people with AKI. Buffered dialysates and solutions used in HDF or HF have varying effects on acid-base physiology and several electrolytes. The benefits and harms of bicarbonate- versus lactate-buffered HDF or HF solutions for treating patients with AKI remain unclear.
To assess the benefits and harms of bicarbonate- versus lactate-buffered solutions for HDF or HF for treating people with AKI.
We searched the Cochrane Renal Group's Specialised Register to 6 January 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. We also searched the Chinese Biomedical Literature Database.
All randomised controlled trials (RCT) and quasi-RCTs that reported comparisons of bicarbonate-buffered solutions with lactate-buffered solutions for AKI were selected for inclusion irrespective of publication status or language.
Two authors independently assessed titles and abstracts, and where necessary the full text of studies, to determine which satisfied our inclusion criteria. Data were extracted by two authors who independently assessed studies for eligibility and quality using a standardised data extraction form. Methodological quality was assessed using the Cochrane risk of bias tool. Results were expressed as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI).
We identified four studies (171 patients) that met our inclusion criteria. Overall, study quality was suboptimal. There were significant reporting omissions related to methodological issues and potential harms. Outcome measures were not defined or reported adequately. The studies were small and lacked follow-up phases.Serum lactate levels were significantly lower in patients treated with bicarbonate-buffered solutions (4 studies, 171 participants: MD -1.09 mmol/L, 95% CI -1.30 to -0.87; I(2) = 0%). There were no differences in mortality (3 studies, 163 participants: RR 0.76, 95% CI 0.50 to 1.15; I(2) = 0%); serum bicarbonate levels (3 studies, 163 participants: MD 0.27 mmol/L, 95% CI -1.45 to 1.99; I(2) = 78%), serum creatinine (2 studies, 137 participants: MD -22.81 µmol/L, 95% CI -129.61 to 83.99; I(2) = 73%), serum base excess (3 studies, 145 participants: MD 0.80, 95% CI -0.91 to 2.50; I(2) = 38%), serum pH (4 studies, 171 participants: MD 0.01, 95% CI -0.02 to 0.03; I(2) = 70%) or carbon dioxide partial pressure (3 studies, 151 participants: MD -1.04, 95% CI -3.84 to 1.76; I(2) = 83%). A single study reported fewer cardiovascular events (RR 0.39, 95% CI 0.20 to 0.79), higher mean arterial pressure (10.25 mm Hg, 95% CI 6.68 to 13.82) and less hypotensive events (RR 0.44, 95% CI 0.26 to 0.75) in patients receiving bicarbonate-buffered solutions. One study reported no significant difference in central venous pressure (MD 2.00 cm H2O, 95% CI -0.7 to, 4.77). Total length of hospital and ICU stay and relapse were not reported by any of the included studies.
AUTHORS' CONCLUSIONS: There were no significant different between bicarbonate- and lactate-buffered solutions for mortality, serum bicarbonate levels, serum creatinine, serum base excess, serum pH, carbon dioxide partial pressure, central venous pressure and serum electrolytes. Patients treated with bicarbonate-buffered solutions may experience fewer cardiovascular events, lower serum lactate levels, higher mean arterial pressure and less hypotensive events. With the exception of mortality, we were not able to assess the main primary outcomes of this review - length of time in ICU, total length of hospital stay and relapse.
急性肾损伤（AKI）是一种严重的肾功能丧失，导致患者无法适当排泄含氮废物和肌酐。连续性血液透析滤过（HDF）或血液滤过（HF）是常用于AKI患者的肾脏替代疗法。HDF或HF中使用的缓冲透析液和溶液对酸碱生理和几种电解质有不同影响。碳酸氢盐缓冲与乳酸盐缓冲的HDF或HF溶液治疗AKI患者的利弊仍不明确。
评估碳酸氢盐缓冲与乳酸盐缓冲溶液用于HDF或HF治疗AKI患者的利弊。
我们通过与试验检索协调员联系，使用与本综述相关的检索词，检索了截至2015年1月6日的Cochrane肾脏组专业注册库。我们还检索了中国生物医学文献数据库。
所有报告了碳酸氢盐缓冲溶液与乳酸盐缓冲溶液治疗AKI比较的随机对照试验（RCT）和半随机对照试验均被纳入，无论其发表状态或语言如何。
两位作者独立评估标题和摘要，必要时评估研究全文，以确定哪些符合我们的纳入标准。数据由两位作者提取，他们使用标准化数据提取表独立评估研究的资格和质量。使用Cochrane偏倚风险工具评估方法学质量。结果以风险比（RR）或平均差（MD）及95%置信区间（CI）表示。
我们确定了四项符合纳入标准的研究（171例患者）。总体而言，研究质量欠佳。在方法学问题和潜在危害方面存在重大报告遗漏。结局指标未得到充分定义或报告。这些研究规模较小且缺乏随访阶段。接受碳酸氢盐缓冲溶液治疗的患者血清乳酸水平显著降低（4项研究，171名参与者：MD -1.09 mmol/L，95%CI -1.30至-0.87；I² = 0%）。死亡率无差异（3项研究，163名参与者：RR 0.76，95%CI 0.50至1.15；I² = 0%）；血清碳酸氢盐水平（3项研究，163名参与者：MD 0.27 mmol/L，95%CI -1.45至1.99；I² = 78%），血清肌酐（2项研究，137名参与者：MD -22.81 µmol/L，95%CI -129.61至83.99；I² = 73%），血清碱剩余（3项研究，145名参与者：MD 0.80，95%CI -0.91至2.50；I² = 38%），血清pH值（4项研究，171名参与者：MD 0.01，95%CI -0.02至0.03；I² = 70%）或二氧化碳分压（3项研究，151名参与者：MD -1.04，95%CI -3.84至1.76；I² = 83%）。一项研究报告接受碳酸氢盐缓冲溶液治疗的患者心血管事件较少（RR 0.39，95%CI 0.20至0.79），平均动脉压较高（10.25 mmHg，95%CI 6.68至13.82）且低血压事件较少（RR 0.44，95%CI 0.26至0.75）。一项研究报告中心静脉压无显著差异（MD 2.00 cmH₂O，95%CI -0.7至4.77）。纳入的任何研究均未报告住院和ICU住院总时长及复发情况。
碳酸氢盐缓冲与乳酸盐缓冲溶液在死亡率、血清碳酸氢盐水平、血清肌酐、血清碱剩余、血清pH值、二氧化碳分压、中心静脉压和血清电解质方面无显著差异。接受碳酸氢盐缓冲溶液治疗的患者可能经历较少的心血管事件、较低的血清乳酸水平、较高的平均动脉压和较少的低血压事件。除死亡率外，我们无法评估本综述的主要主要结局——ICU住院时长、住院总时长和复发情况。
