Pickup Luke C, Law Jonathan P, Radhakrishnan Ashwin, Price Anna M, Loutradis Charalampos, Smith Toby O, Edwards Nicola C, Steeds Richard P, Townend Jonathan N, Ferro Charles J
Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
ESC Heart Fail. 2021 Jun;8(3):2045-2057. doi: 10.1002/ehf2.13283. Epub 2021 Mar 15.
This study aimed to examine if the cardiac changes associated with uraemic cardiomyopathy are reversed by renal transplantation.
MEDLINE, Embase, OpenGrey, and the Cochrane Library databases were searched from 1950 to March 2020. The primary outcome measure was left ventricular mass index. Secondary outcome measures included left ventricular dimensions and measures of diastolic and systolic function. Studies were included if they used any imaging modality both before and after successful renal transplantation. Data were analysed through meta-analysis approaches. Weight of evidence was assessed through the Grading of Recommendations Assessment, Development and Evaluation system. Twenty-three studies used echocardiography, and three used cardiac magnetic resonance imaging as their imaging modality. The methodological quality of the evidence was generally poor. Four studies followed up control groups, two using cardiac magnetic resonance imaging and two using echocardiography. Meta-analysis of these studies indicated that there was no difference in left ventricular mass index between groups following transplantation {standardized mean difference -0.07 [95% confidence interval (CI) -0.41 to 0.26]; P = 0.67}. There was also no difference observed in left ventricular ejection fraction [mean difference 0.39% (95% CI -4.09% to 4.87%); P = 0.86] or left ventricular end-diastolic volume [standardized mean difference -0.24 (95% CI -0.94 to 0.45); P = 0.49]. Inconsistent reporting of changes in diastolic dysfunction did not allow for any meaningful analysis or interpretation.
The evidence does not support the notion that uraemic cardiomyopathy is reversible by renal transplantation. However, the evidence is limited by methodological weaknesses, which should be considered when interpreting these findings.
本研究旨在探讨与尿毒症性心肌病相关的心脏改变是否可通过肾移植得到逆转。
检索了1950年至2020年3月的MEDLINE、Embase、OpenGrey和Cochrane图书馆数据库。主要结局指标为左心室质量指数。次要结局指标包括左心室尺寸以及舒张和收缩功能指标。纳入的研究需在成功肾移植前后均使用任何成像方式。通过荟萃分析方法对数据进行分析。证据权重通过推荐分级评估、制定和评价系统进行评估。23项研究使用超声心动图，3项研究使用心脏磁共振成像作为其成像方式。证据的方法学质量总体较差。4项研究对对照组进行了随访，2项使用心脏磁共振成像，2项使用超声心动图。对这些研究的荟萃分析表明，移植后各组之间左心室质量指数无差异{标准化均数差-0.07[95%置信区间(CI)-0.41至0.26]；P = 0.67}。左心室射血分数[均数差0.39%(95%CI -4.09%至4.87%)；P = 0.86]或左心室舒张末期容积[标准化均数差-0.24(95%CI -0.94至0.45)；P = 0.49]也未观察到差异。关于舒张功能障碍变化的报告不一致，无法进行任何有意义的分析或解释。
证据不支持尿毒症性心肌病可通过肾移植逆转的观点。然而，证据受到方法学缺陷的限制，在解释这些结果时应予以考虑。
