重症监护病房中急性肾损伤肾脏替代治疗方式的系统评价与荟萃分析。

Systematic review and meta-analysis of renal replacement therapy modalities for acute kidney injury in the intensive care unit.

作者信息

Nash Danielle M, Przech Sebastian, Wald Ron, O'Reilly Daria

机构信息

Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.

Department of Medicine, London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.

出版信息

J Crit Care. 2017 Oct;41:138-144. doi: 10.1016/j.jcrc.2017.05.002. Epub 2017 May 9.

DOI:10.1016/j.jcrc.2017.05.002

PMID:28525779

Abstract

PURPOSE

To compare clinical outcomes among critically ill adults with acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT), intermittent hemodialysis (IHD) or sustained low efficiency dialysis (SLED).

MATERIALS AND METHODS

We completed a systematic review and meta-analysis of studies published in 2015 or earlier using MEDLINE®, EMBASE®, Cochrane databases and grey literature. Eligible studies included randomized clinical trials (RCTs) or prospective cohort studies comparing outcomes of mortality, dialysis dependence or length of stay among critically ill adults receiving CRRT, IHD or SLED to treat AKI. Mortality and dialysis dependence from RCTs were pooled using meta-analytic techniques. Length of stay from RCTs and results from prospective cohort studies were described qualitatively.

RESULTS

Twenty-one studies were eligible. RRT modality was not associated with in-hospital mortality (CRRT vs IHD: RR 1.00 [95% CI, 0.92-1.09], CRRT vs SLED: RR 1.23 [95% CI, 1.00-1.51]) or dialysis dependence (CRRT vs IHD: RR 0.90 [95% CI, 0.59-1.38], CRRT vs SLED: RR 1.15 [95% CI, 0.67-1.99]).

CONCLUSIONS

We did not find a definitive advantage for any RRT modality on short-term patient or kidney survival. Well-designed, adequately-powered trials are needed to better define the role of RRT modalities for treatment of critically ill patients with AKI.

摘要

目的

比较接受持续肾脏替代治疗（CRRT）、间歇性血液透析（IHD）或持续性低效透析（SLED）的急性肾损伤（AKI）重症成年患者的临床结局。

材料与方法

我们使用MEDLINE®、EMBASE®、Cochrane数据库和灰色文献对2015年或更早发表的研究进行了系统评价和荟萃分析。符合条件的研究包括随机临床试验（RCT）或前瞻性队列研究，比较接受CRRT、IHD或SLED治疗AKI的重症成年患者的死亡率、透析依赖或住院时间结局。使用荟萃分析技术汇总RCT中的死亡率和透析依赖情况。定性描述RCT中的住院时间和前瞻性队列研究的结果。

结果

21项研究符合条件。肾脏替代治疗方式与住院死亡率（CRRT对比IHD：RR 1.00 [95% CI，0.92 - 1.09]，CRRT对比SLED：RR 1.23 [95% CI，1.00 - 1.51]）或透析依赖（CRRT对比IHD：RR 0.90 [95% CI，0.59 - 1.38]，CRRT对比SLED：RR 1.15 [95% CI，0.67 - 1.99]）无关。