Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China.
Int Urol Nephrol. 2021 Sep;53(9):1911-1921. doi: 10.1007/s11255-021-02805-x. Epub 2021 Mar 6.
Intradialytic hypotension (IDH) is a serious complication in dialysis patients. Diuretics might reduce the incidence of IDH by decreasing ultrafiltration. However, the effect of diuretics on IDH in maintenance dialysis patients is still unclear.
We searched Medline, Embase, the Cochrane Library, China National Knowledge Infrastructure and clinical trials registries from 1945 to May 2019. Randomized controlled trials (RCTs) or observational studies about IDH in maintenance dialysis with diuretics were included.
Seven studies including 28,226 patients were included, of which 4 were RCTs involving mineralocorticoid receptor antagonists (MRAs) and 3 were observational studies involving loop diuretics. There was a trend that a lower incidence rate of IDH in maintenance dialysis patients who used loop diuretics than control, although the result was not statistically significant (OR 0.65, 95% CI 0.34-1.22, P = 0.18). Similarly, lower incidence rate of all-cause mortality (OR 0.92, 95% CI 0.87-0.99; P = 0.02) and cardiovascular (CV) mortality (OR 0.86, 95% CI 0.75-0.99, P = 0.03) in dialysis patients who used loop diuretics than control. On the contrary, there were no significant difference in the incidence of IDH (OR 1.35, 95% CI 0.78-2.34, P = 0.29) and all-cause mortality (OR 0.73, 95% CI 0.26-2.01; P = 0.54) and CV mortality (OR 0.57, 95% CI 0.14-2.25; P = 0.42) in maintenance dialysis patients who used MRAs compared with control.
Loop diuretics, but not MRAs, might have a potential benefit to reduce the incidence rate of IDH, all-cause mortality and CV mortality. More high-quality studies are needed to strengthen the arguments.
透析中低血压（IDH）是透析患者的一种严重并发症。利尿剂通过减少超滤量可能会降低 IDH 的发生率。然而，利尿剂对维持性透析患者 IDH 的影响仍不清楚。
我们检索了 1945 年至 2019 年 5 月的 Medline、Embase、Cochrane 图书馆、中国知网和临床试验注册中心，纳入了关于维持性透析中使用利尿剂治疗 IDH 的随机对照试验（RCT）或观察性研究。
纳入了 7 项研究，共 28226 例患者，其中 4 项 RCT 涉及醛固酮受体拮抗剂（MRA），3 项观察性研究涉及袢利尿剂。虽然结果没有统计学意义（OR 0.65，95%CI 0.34-1.22，P=0.18），但使用袢利尿剂的维持性透析患者 IDH 的发生率有降低的趋势。同样，使用袢利尿剂的透析患者全因死亡率（OR 0.92，95%CI 0.87-0.99；P=0.02）和心血管死亡率（OR 0.86，95%CI 0.75-0.99，P=0.03）的发生率也低于对照组。相反，使用 MRA 的维持性透析患者 IDH 的发生率（OR 1.35，95%CI 0.78-2.34，P=0.29）、全因死亡率（OR 0.73，95%CI 0.26-2.01；P=0.54）和心血管死亡率（OR 0.57，95%CI 0.14-2.25；P=0.42）与对照组相比无显著差异。
袢利尿剂而非 MRA 可能具有降低 IDH 发生率、全因死亡率和心血管死亡率的潜在益处。需要更多高质量的研究来加强论证。
