中性pH、低葡萄糖降解产物腹膜透析液对残余肾功能、尿量及超滤的影响：一项系统评价和Meta分析
Effect of Neutral-pH, Low-Glucose Degradation Product Peritoneal Dialysis Solutions on Residual Renal Function, Urine Volume, and Ultrafiltration: A Systematic Review and Meta-Analysis.
作者信息
Yohanna Seychelle, Alkatheeri Ali M A, Brimble Scott K, McCormick Brendan, Iansavitchous Arthur, Blake Peter G, Jain Arsh K
机构信息
Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada;
Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada; Department of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia;
出版信息
Clin J Am Soc Nephrol. 2015 Aug 7;10(8):1380-8. doi: 10.2215/CJN.05410514. Epub 2015 Jun 5.
BACKGROUND AND OBJECTIVES
Neutral-pH, low-glucose degradation products solutions were developed in an attempt to lessen the adverse effects of conventional peritoneal dialysis solutions. A systematic review was performed evaluating the effect of these solutions on residual renal function, urine volume, peritoneal ultrafiltration, and peritoneal small-solute transport (dialysate to plasma creatinine ratio) over time.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Multiple electronic databases were searched from January of 1995 to January of 2013. Randomized trials reporting on any of four prespecified outcomes were selected by consensus among multiple reviewers.
RESULTS
Eleven trials of 643 patients were included. Trials were generally of poor quality. The meta-analysis was performed using a random effects model. The use of neutral-pH, low-glucose degradation products solutions resulted in better preserved residual renal function at various study durations, including >1 year (combined analysis: 11 studies; 643 patients; standardized mean difference =0.17 ml/min; 95% confidence interval, 0.01 to 0.32), and greater urine volumes (eight studies; 598 patients; mean difference =128 ml/d; 95% confidence interval, 58 to 198). There was no significant difference in peritoneal ultrafiltration (seven studies; 571 patients; mean difference =-110; 95% confidence interval, -312 to 91) or dialysate to plasma creatinine ratio (six studies; 432 patients; mean difference =0.03; 95% confidence interval, 0.00 to 0.06).
CONCLUSIONS
The use of neutral-pH, low-glucose degradation products solutions results in better preservation of residual renal function and greater urine volumes. The effect on residual renal function occurred early and persisted beyond 12 months. Additional studies are required to evaluate the use of neutral-pH, low-glucose degradation products solutions on hard clinical outcomes.
背景与目的
研发了中性pH、低葡萄糖降解产物溶液，旨在减轻传统腹膜透析液的不良反应。进行了一项系统评价，评估这些溶液对残余肾功能、尿量、腹膜超滤及腹膜小溶质转运（透析液与血浆肌酐比值）随时间的影响。
设计、地点、参与者与测量：检索了1995年1月至2013年1月的多个电子数据库。通过多位评审员的共识，选择了报告任何一项预先指定的四项结果的随机试验。
结果
纳入了11项试验，共643例患者。试验质量普遍较差。采用随机效应模型进行荟萃分析。使用中性pH、低葡萄糖降解产物溶液在不同研究时长下能更好地保留残余肾功能，包括超过1年（合并分析：11项研究；643例患者；标准化均差=0.17ml/min；95%置信区间，0.01至0.32），且尿量更多（8项研究；598例患者；均差=128ml/d；95%置信区间，58至198）。腹膜超滤（7项研究；571例患者；均差=-110；95%置信区间，-312至91）或透析液与血浆肌酐比值（6项研究；432例患者；均差=0.03；95%置信区间，0.00至0.06）无显著差异。
结论
使用中性pH、低葡萄糖降解产物溶液能更好地保留残余肾功能并增加尿量。对残余肾功能的影响出现较早且持续超过12个月。需要进一步研究评估中性pH、低葡萄糖降解产物溶液在硬临床结局方面的应用。
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