Division of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
The Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Nephrology (Carlton). 2020 Aug;25(8):607-615. doi: 10.1111/nep.13698. Epub 2020 Feb 18.
Acute kidney injury (AKI) is associated with poor short-term and long-term clinical outcomes. The role of nephrology follow-up in post-AKI management remains uncertain.
A systematic review and meta-analysis were performed examining all randomized controlled trials and observational studies assessing the effect of nephrology follow-up on patients' clinical outcomes. The primary outcome was all-cause mortality. The secondary outcomes were renal outcomes, which were defined as a composite of requirement of permanent dialysis and recurrent AKI. Pooled analysis was performed using a random-effect model.
We identified six studies (8972 patients, mean follow-up of 49 months). Five were retrospective cohort studies and one was a prospective cohort study. Risk of bias was a concern with all studied. Only four studies reported primary and/or secondary outcomes and were included. Compared with patients without nephrology follow-up, patients with nephrology follow-up had significantly reduced mortality by 22% (three studies, 3240 patients, relative risk [RR] = 0.78, 95% confidence interval [CI] = 0.70-0.88, I = 0.0%). Nephrology follow-up did not improve composite renal outcomes with high heterogeneity due to significant differences in reported renal outcomes and follow-up period (two studies, 2537 patients, RR = 1.72, 95% CI = 0.49-6.05, I = 90.1%).
Current evidence from observational studies is biased. It suggests long-term survival benefits with post-discharge nephrology follow-up in AKI patients. However, due to its low quality, such evidence is only hypothesis-generating. Nonetheless, it provides a rationale for future randomized controlled trials of nephrology follow-up in AKI patients. SUMMARY AT A GLANCE The present meta-analysis assessed the effect of nephrology follow-up on patients' clinical outcomes, and suggested long-term survival benefits in acute kidney injury (AKI) survivors. Although the study inherently comprises potential risks of bias due to paucity of available data, the results provide a rationale for future randomized controlled trials.
急性肾损伤（AKI）与短期和长期临床结局不良相关。肾脏病学随访在 AKI 后的管理中的作用仍不确定。
系统回顾和荟萃分析评估了所有评估肾脏病学随访对患者临床结局影响的随机对照试验和观察性研究。主要结局为全因死亡率。次要结局为肾脏结局，定义为永久性透析和复发性 AKI 的综合需求。使用随机效应模型进行汇总分析。
我们确定了六项研究（8972 名患者，平均随访 49 个月）。其中五项为回顾性队列研究，一项为前瞻性队列研究。所有研究的偏倚风险均令人担忧。只有四项研究报告了主要和/或次要结局，并被纳入。与未接受肾脏病学随访的患者相比，接受肾脏病学随访的患者死亡率显著降低 22%（三项研究，3240 名患者，相对风险 [RR] = 0.78，95%置信区间 [CI] = 0.70-0.88，I = 0.0%）。由于报告的肾脏结局和随访期存在显著差异，肾脏病学随访并未改善复合肾脏结局，且异质性很高（两项研究，2537 名患者，RR = 1.72，95%CI = 0.49-6.05，I = 90.1%）。
目前来自观察性研究的证据存在偏差。它表明 AKI 患者出院后接受肾脏病学随访可带来长期生存获益。然而，由于其质量较低，此类证据仅具有产生假说的作用。尽管如此，它为 AKI 患者的肾脏病学随访的未来随机对照试验提供了依据。
本荟萃分析评估了肾脏病学随访对患者临床结局的影响，并提示 AKI 幸存者有长期生存获益。尽管由于缺乏可用数据，该研究固有地存在潜在偏倚风险，但结果为未来的随机对照试验提供了依据。
