急性肾损伤患者早期开始肾脏替代治疗：一项系统评价和荟萃分析。

Early initiation of renal replacement treatment in patients with acute kidney injury: A systematic review and meta-analysis.

作者信息

Wang Hongwei, Li Liwei, Chu Qinjun, Wang Yong, Li Zhisong, Zhang Wei, Li Lanlan, He Long, Ai Yanqiu

机构信息

Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China.

出版信息

Medicine (Baltimore). 2016 Nov;95(46):e5434. doi: 10.1097/MD.0000000000005434.

DOI:10.1097/MD.0000000000005434

PMID:27861388

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5120945/

Abstract

BACKGROUND

Acute kidney injury (AKI) is associated with a substantially increased risk of mortality for many hospitalized patients. It has been suggested that early initiation of renal replacement treatment has a favorable outcome in critically ill patients complicated with AKI. However, results of studies evaluating the effect of early initiation strategy of renal replacement treatment on AKI have been controversial and contradictory. The aim of this meta-analysis is to examine the effect of early initiation of renal replacement treatment on patients with AKI.

METHODS

The authors searched relevant studies in PubMed, EMBASE, and the Cochrane Library through August 2016. We searched for all eligible randomized controlled trials with regard to the role of early initiation of renal replacement treatment in mortality among patients with AKI. We extracted the following information from each study: mortality, length of stay in intensive care unit (ICU), and length of stay in hospital. Random and fixed effect models were used for pooling data.

RESULTS

Twelve trials including 1756 patients were included. The results of this meta-analysis showed that there was no significant difference between the mortality of early and delayed strategy for the initiation of renal replacement treatment using the random effect model (odds ratio = 0.78; 95% confidence interval [CI], 0.52-1.19; P = 0.25), with wild heterogeneity (chi = 33.50; I = 67%). Analyses from subgroup sepsis and postsurgery came to similar results. In addition, compared with delayed initiation strategy, early initiation showed no significant advantage in length of stay in ICU (mean difference = -0.80; 95% CI, -2.59 to 0.99; P = 0.56) and length of stay in hospital (mean difference = -7.69; 95% CI, -16.14 to 0.76; P = 0.07).

CONCLUSION

According to the results from present meta-analysis, early initiation of renal replacement treatment showed no survival benefits in patients with AKI. To achieve optimal timing of renal replacement treatment, further large multicenter randomized trials, with widely accepted and standardized definition of early initiation, are still needed.

摘要

背景

急性肾损伤（AKI）与许多住院患者的死亡风险大幅增加相关。有人提出，对于合并AKI的危重症患者，早期开始肾脏替代治疗可带来良好预后。然而，评估肾脏替代治疗早期启动策略对AKI影响的研究结果一直存在争议且相互矛盾。本荟萃分析的目的是研究肾脏替代治疗早期启动对AKI患者的影响。

方法

作者检索了截至2016年8月的PubMed、EMBASE和Cochrane图书馆中的相关研究。我们搜索了所有关于肾脏替代治疗早期启动在AKI患者死亡率方面作用的合格随机对照试验。我们从每项研究中提取了以下信息：死亡率、重症监护病房（ICU）住院时间和住院时间。采用随机效应模型和固定效应模型汇总数据。

结果

纳入了12项试验，共1756例患者。本荟萃分析结果显示，采用随机效应模型时，肾脏替代治疗早期启动和延迟启动策略的死亡率之间无显著差异（优势比 = 0.78；95%置信区间[CI]，0.52 - 1.19；P = 0.25），存在显著异质性（卡方 = 33.50；I² = 67%）。亚组脓毒症和术后分析得出了类似结果。此外，与延迟启动策略相比，早期启动在ICU住院时间（平均差 = -0.80；95%CI，-2.59至0.99；P = 0.56）和住院时间（平均差 = -7.69；95%CI，-16.14至0.76；P = 0.07）方面无显著优势。