Division of Nephrology, Department of Scienze Mediche e Chirurgiche Avanzate, University of Campania "Luigi Vanvitelli", Via M. Longo 50, 80138, Naples, Italy.
Nephrology and Dialysis Division, University Magna Graecia in Catanzaro, Catanzaro, Italy.
J Nephrol. 2019 Oct;32(5):823-836. doi: 10.1007/s40620-018-00577-9. Epub 2019 Jan 2.
Incremental dialysis may preserve residual renal function and improve survival in comparison with full-dose dialysis; however, available evidence is limited. We therefore compared all-cause mortality and residual kidney function (RKF) loss in incremental and full-dose dialysis and time to full-dose dialysis in incremental hemodialysis (IHD) and incremental peritoneal dialysis (IPD).
We performed a systematic review and meta-analysis of cohort studies of adults with ESRD starting IHD and IPD. We identified in PubMed and Web of Science database all cohort studies evaluating incremental dialysis evaluating three outcomes: all-cause mortality, RKF loss, time to full dialysis. IPD was defined as < 3 daily dwells in Continuous Ambulatory Peritoneal Dialysis and < 5 sessions per week in Automated Peritoneal Dialysis, while IHD was defined as < 3 HD sessions per week.
22 studies (75,292 participants), 15 in HD and 7 in PD, were analyzed. Mean age at dialysis start was 62 and 57 years in IHD and IPD subjects, respectively. When compared to full dose, incremental dialysis (IHD or IPD) had an overall mortality risk of 1.14 [95% CI 0.85-1.52] with high heterogeneity among studies (I 86%, P < 0.001), and lower mean RKF loss (- 0.58 ml/min/months, 95% CI 0.16-1.01, P = 0.007). Overall, time to full-dose dialysis was 12.1 months (95% CI 9.8-14.3) with no difference between IHD and IPD (P = 0.217).
Incremental dialysis allows longer preservation of RKF thus deferring full-dose dialysis, by about 1 year in HD and PD, with no increase in mortality risk. Large and adequate studies are needed to confirm these findings.
与全剂量透析相比，增量透析可能保留残余肾功能并提高生存率；然而，现有证据有限。因此，我们比较了增量和全剂量透析的全因死亡率和残余肾功能（RKF）损失，以及增量血液透析（IHD）和增量腹膜透析（IPD）达到全剂量透析的时间。
我们对开始 IHD 和 IPD 的 ESRD 成人的队列研究进行了系统评价和荟萃分析。我们在 PubMed 和 Web of Science 数据库中查找了所有评估增量透析的队列研究，评估了三个结局：全因死亡率、RKF 损失、达到全透析时间。IPD 定义为连续流动腹膜透析每日<3 次透析和每周<5 次自动化腹膜透析，而 IHD 定义为每周<3 次血液透析。
分析了 22 项研究（75292 名参与者），其中 15 项在血液透析中，7 项在腹膜透析中。透析开始时的平均年龄分别为 IHD 和 IPD 患者 62 和 57 岁。与全剂量相比，增量透析（IHD 或 IPD）的总体死亡率风险为 1.14 [95%CI 0.85-1.52]，但研究之间存在高度异质性（I 86%，P<0.001），RKF 损失的平均值较低（-0.58ml/min/月，95%CI 0.16-1.01，P=0.007）。总体而言，达到全剂量透析的时间为 12.1 个月（95%CI 9.8-14.3），IHD 和 IPD 之间无差异（P=0.217）。
增量透析可更长时间地保留 RKF，从而延迟全剂量透析，在血液透析和腹膜透析中大约延迟 1 年，且不增加死亡率风险。需要进行大型和充分的研究来证实这些发现。
