Zhao Yaya, Pei Xiaohua, Zhao Weihong
Department of Geriatrics, Division of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Ther Apher Dial. 2018 Dec;22(6):600-608. doi: 10.1111/1744-9987.12721. Epub 2018 Jul 31.
The optimal time of dialysis initiation among patients with chronic kidney disease (CKD) is unclear in recent years. We performed a meta-analysis to assess the association of early vs. late initiation of dialysis with estimated glomerular filtration rate. PUBMED, EMBASE, the Cochrane Library, and article reference lists were searched for relevant observational trials. A pooled hazard ratio (HR) with 95% CI was used to estimate the mortality risk. Twenty-six cohort studies and one randomized controlled trial were identified. Early start of dialysis was associated with the increased risk of mortality (HR = 1.23, 95% CI: 1.04-1.43) compared with late start of dialysis. In the subgroup analysis, age younger than 65 years at the early start of dialysis demonstrated higher mortality (HR = 1.20, 95% CI: 1.05-1.35) than the late start. Compared with peritoneal dialysis, the pooled HR with HD was 1.25 (95% CI: 1.17-1.34). Early start of dialysis increased the mortality risk compared with late start among patients with CKD.
近年来，慢性肾脏病（CKD）患者开始透析的最佳时机尚不清楚。我们进行了一项荟萃分析，以评估早期与晚期开始透析与估计肾小球滤过率之间的关联。检索了PUBMED、EMBASE、Cochrane图书馆以及文章参考文献列表，以查找相关的观察性试验。采用合并风险比（HR）及95%置信区间（CI）来估计死亡风险。共纳入26项队列研究和1项随机对照试验。与晚期开始透析相比，早期开始透析与死亡风险增加相关（HR = 1.23，95% CI：1.04 - 1.43）。在亚组分析中，透析早期年龄小于65岁者的死亡率高于晚期开始透析者（HR = 1.20，95% CI：1.05 - 1.35）。与腹膜透析相比，血液透析的合并HR为1.25（95% CI：1.17 - 1.34）。在CKD患者中，与晚期开始透析相比，早期开始透析增加了死亡风险。
