Andonovic Mark, Shemilt Richard, Sim Malcolm, Traynor Jamie P, Shaw Martin, Mark Patrick B, Puxty Kathryn A
Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow, UK.
Department of Nephrology, Queen Elizabeth University Hospital, Glasgow, UK.
J Intensive Care Soc. 2021 Feb;22(1):67-77. doi: 10.1177/1751143720901688. Epub 2020 Feb 6.
Acute kidney injury is associated with high mortality, and the optimal time to start renal replacement therapy for acute kidney injury is unknown despite several randomised controlled trials on the subject. We performed a systematic review and meta-analysis to assess the effect of earlier initiation of renal replacement therapy for acute kidney injury on mortality and reported secondary outcomes.
All literature in databases EMBASE, MEDLINE and CENTRAL was searched from January 1970 to March 2019 using terms related to renal replacement therapy, timing and randomised controlled trials. All randomised controlled trials with 25 or more adult participants suffering from acute kidney injury comparing timing of renal replacement therapy were included. The results of the selected studies were pooled and expressed in terms of risk ratios (RR) and 95% confidence intervals (95% CI) using a random effects model.
A total of 7008 records were identified; 94 were selected for full text review of which 10 were included in the final meta-analysis. The 10 studies comprised 1956 participants (989 'early' group; 967 'late' group) with 918 total deaths; the analysis demonstrated no significant differences between the 'early' and 'late' renal replacement therapy groups (RR = 0.98 (95% CI = 0.84, 1.15)) for mortality. No significant differences between groups were evident for period-wise mortality; dialysis dependence; recovery of renal function; length of intensive care unit or hospital stay; or number of renal replacement therapies, mechanical ventilation and vasopressor-free days.
Current evidence does not support the use of early renal replacement therapy for patients with acute kidney injury. Data from ongoing and future randomised controlled trials are required to strengthen the evidence base in the area.
急性肾损伤与高死亡率相关，尽管针对该主题进行了多项随机对照试验，但急性肾损伤开始肾脏替代治疗的最佳时机仍不明确。我们进行了一项系统评价和荟萃分析，以评估急性肾损伤早期开始肾脏替代治疗对死亡率及报告的次要结局的影响。
使用与肾脏替代治疗、时机和随机对照试验相关的术语，检索了1970年1月至2019年3月期间EMBASE、MEDLINE和CENTRAL数据库中的所有文献。纳入所有比较肾脏替代治疗时机的、有25名或更多成年急性肾损伤患者的随机对照试验。采用随机效应模型对所选研究结果进行汇总，并以风险比（RR）和95%置信区间（95%CI）表示。
共识别出7008条记录；选择94条进行全文审查，其中10条纳入最终的荟萃分析。这10项研究包括1956名参与者（“早期”组989人；“晚期”组967人），共918例死亡；分析表明，“早期”和“晚期”肾脏替代治疗组在死亡率方面无显著差异（RR = 0.98（95%CI = 0.84, 1.15））。在分期死亡率、透析依赖、肾功能恢复、重症监护病房或住院时间、肾脏替代治疗次数、机械通气天数和无血管活性药物天数方面，各组之间均无明显差异。
目前的证据不支持对急性肾损伤患者使用早期肾脏替代治疗。需要来自正在进行和未来的随机对照试验的数据来加强该领域的证据基础。
