Al Saadon Abdalrhman, Katulka Riley, Sebastianski Meghan, Featherstone Robin, Vandermeer Ben, Gibney R T Noel, Rewa Oleksa G, Bagshaw Sean M
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Alberta Strategy for Patient Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada.
BMJ Open. 2018 Nov 25;8(11):e023306. doi: 10.1136/bmjopen-2018-023306.
Renal replacement therapy (RRT) is a complex and expensive form of life-sustaining therapy, reserved for our most acutely ill patients. While a number of randomised trials have evaluated the optimal timing to start RRT among critically ill patients in the intensive care unit (ICU), there has been a paucity of trials providing guidance on when and under what circumstances to ideally liberate a patient from RRT. We are conducting a systematic review and meta-analysis to identify clinical and biochemical markers that predict kidney recovery and successful liberation from acute RRT among critically ill patients with acute kidney injury.
Our comprehensive search strategy was developed in consultation with a research librarian and independently peer-reviewed by a second librarian. We will search electronic databases: Ovid Medline, Ovid Embase and Wiley Cochrane Library. Selected grey literature sources will also be searched. Our search strategies will focus on concepts related to RRT (ie, intermittent haemodialysis, slow low-efficiency dialysis, continuous renal replacement therapy), intensive care (ie, involving any ICU setting) and discontinuation of therapy (ie, either clinical, physiological and biochemical parameters of weaning acute RRT) from 1990 to October 10, 2017. Citation screening, selection, quality assessment and data abstraction will be performed in duplicate. Studies will, where possible, be pooled in statistical meta-analysis. When deemed sufficiently clinically homogenous, and we have four or more studies reporting, sensitivities and specificities will be pooled simultaneously using a hierarchical summary receiver operator characteristic curve and bivariate analysis.
Our systematic review will synthesise the literature on clinical and biochemical markers that predict liberation from RRT. Research ethics approval is not required.
CRD42018074615.
肾脏替代治疗（RRT）是一种复杂且昂贵的维持生命的治疗方式，仅用于病情最危急的患者。虽然有多项随机试验评估了重症监护病房（ICU）中危重症患者开始RRT的最佳时机，但关于何时以及在何种情况下理想地使患者脱离RRT的试验却很少。我们正在进行一项系统评价和荟萃分析，以确定预测急性肾损伤危重症患者肾脏恢复及成功脱离急性RRT的临床和生化标志物。
我们与一位研究馆员协商制定了全面的检索策略，并由另一位馆员进行独立的同行评审。我们将检索电子数据库：Ovid Medline、Ovid Embase和Wiley Cochrane图书馆。还将检索选定的灰色文献来源。我们的检索策略将聚焦于与RRT（即间歇性血液透析、缓慢低效透析、连续性肾脏替代治疗）、重症监护（即涉及任何ICU环境）以及1990年至2017年10月10日治疗中断（即急性RRT撤机的临床、生理和生化参数）相关的概念。文献筛选、选择、质量评估和数据提取将由两人独立进行。如有可能，将对研究进行统计荟萃分析。当认为临床同质性足够且我们有四项或更多研究报告时，将使用分层汇总接受者操作特征曲线和双变量分析同时汇总敏感性和特异性。
我们的系统评价将综合关于预测脱离RRT的临床和生化标志物的文献。无需研究伦理批准。
CRD42018074615。
