Douvris Adrianna, Hiremath Swapnil, McIntyre Lauralyn, Sikora Lindsey, Weber Catherine, Clark Edward G
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
Syst Rev. 2017 Jun 15;6(1):113. doi: 10.1186/s13643-017-0512-9.
Hemodynamic instability during renal replacement therapy (HIRRT) in the form of intradialytic hypotension (IDH) is a frequent complication of hemodialysis in end-stage kidney disease (ESKD), and most studies have focused on this chronic population. However, HIRRT is also an important concern for critically ill ICU patients with acute kidney injury (AKI), complicating an estimated 30% of dialysis treatments in this population. HIRRT can exacerbate organ hypoperfusion in the setting of critical illness and may negatively impact renal recovery in the AKI population. This is a protocol for a systematic review to synthesize the evidence surrounding dialysis-related interventions used to minimize HIRRT in critically ill patients with RRT-requiring AKI. This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) database.
METHODS/DESIGN: We will search MEDLINE, EMBASE, and CENTRAL databases in collaboration with a health information specialist using a comprehensive search strategy. We will also supplement our search with a scan of the "gray literature" to identify relevant ongoing trials or conference abstracts. Observational studies and clinical trials will be included in our analysis. Our outcomes will include the incidence of HIRRT, dialysis-related complications, in-hospital mortality, and renal recovery. Prior to our search, we performed an initial search of these databases and PROSPERO, which yielded no prior or ongoing systematic reviews on this topic. Two reviewers will independently screen the list of identified abstracts using pre-defined inclusion and exclusion criteria. Two reviewers will then independently extract data from selected studies and undertake an assessment of their quality using validated tools.
HIRRT is a common complication of renal replacement therapy not only in ESKD but also in the critically ill AKI population. It can result in early discontinuation of dialysis, further organ injury from hypoperfusion, and possibly negatively impact renal recovery. This systematic review will synthesize the existing evidence on the interventions employed to predict or prevent episodes HIRRT in critically ill patients with RRT-requiring AKI. This systematic review will allow for an understanding the current evidence for interventions to limit HIRRT in AKI and, in doing so, may also highlight areas in need of further research.
PROSPERO CRD42016037754.
肾替代治疗（HIRRT）期间以透析中低血压（IDH）形式出现的血流动力学不稳定是终末期肾病（ESKD）患者血液透析常见的并发症，大多数研究都集中在这一慢性患者群体。然而，HIRRT也是重症监护病房（ICU）中急性肾损伤（AKI）的重症患者的一个重要问题，据估计，该群体中约30%的透析治疗会出现并发症。HIRRT会加重危重症患者的器官灌注不足，并可能对AKI患者的肾脏恢复产生负面影响。这是一项系统评价方案，旨在综合有关用于尽量减少需要进行肾替代治疗的AKI重症患者的HIRRT的透析相关干预措施的证据。该方案已在国际前瞻性系统评价注册库（PROSPERO）数据库中注册。
方法/设计：我们将与一名健康信息专家合作，采用全面的检索策略检索MEDLINE、EMBASE和CENTRAL数据库。我们还将通过浏览“灰色文献”来补充检索，以识别相关的正在进行的试验或会议摘要。观察性研究和临床试验将纳入我们的分析。我们的结局指标将包括HIRRT的发生率、透析相关并发症、住院死亡率和肾脏恢复情况。在检索之前，我们对这些数据库和PROSPERO进行了初步检索，未发现关于该主题的既往或正在进行的系统评价。两名评审员将使用预先定义的纳入和排除标准独立筛选已识别摘要列表。然后，两名评审员将独立从选定的研究中提取数据，并使用经过验证的工具对其质量进行评估。
HIRRT不仅是ESKD患者肾替代治疗常见的并发症，也是AKI重症患者常见的并发症。它可能导致透析提前终止、因灌注不足导致进一步的器官损伤，并可能对肾脏恢复产生负面影响。这项系统评价将综合现有证据，探讨用于预测或预防需要进行肾替代治疗的AKI重症患者发生HIRRT的干预措施。这项系统评价将有助于了解目前限制AKI患者HIRRT的干预措施的证据，并且这样做也可能突出需要进一步研究的领域。
PROSPERO CRD42016037754。
