Division of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R.China.
Coron Artery Dis. 2022 Jan 1;31(1):e73-e79. doi: 10.1097/MCA.0000000000001080.
Several studies have reported that prophylactic dialysis can reduce the mortality of non-dialysis-dependent chronic kidney disease (CKD) patients after cardiac surgery. However, the results of complications in these randomized controlled trials (RCTs) were not consistent. We aimed to perform a meta-analysis to systematically evaluate the effect of prophylactic dialysis in these non-dialysis-dependent CKD patients.
We systematically searched Medline, Embase, Cochrane's Library and other online sources for related RCTs. Effects of prophylactic dialysis on the incidence of 30 days' mortality and postoperative complications were analyzed.
Four RCTs comprising 395 patients were included, all of them treated by coronary artery bypass grafting. Treatment of preoperative and intraoperative prophylactic dialysis significantly reduced the rate of 30-day all-cause mortality (risk ratio [RR]: 0.27, 95% confidence interval [CI], 0.13-0.58, P < 0.001, I2 = 0%) and the incidence of pulmonary complications (RR: 0.39, 95% CI, 0.20-0.77, P = 0.007, I2 = 0%), low cardiac output (RR: 0.29, 95% CI, 0.09-0.99, P = 0.05, I2 = 0%), and acute kidney injury (RR: 0.19, 95% CI: 0.07-0.52, P = 0.001, I2 = 0%). However, there were no statistically significant differences between the dialysis group and the control group in gastrointestinal bleeding, sepsis or multiple organ failure, wound infection, arrhythmia, transient neurologic deficit, stroke and re-exploration for bleeding.
Prophylactic dialysis can improve the 30-day clinical outcomes of non-dialysis-dependent CKD patients undergoing cardiac surgery, it was associated with the 30-day mortality benefit and led to a decrease in the incidence of pulmonary complications, as well as low cardiac output, and acute kidney injury.
多项研究报告称，预防性透析可降低非透析依赖性慢性肾脏病（CKD）患者心脏手术后的死亡率。然而，这些随机对照试验（RCT）的并发症结果并不一致。我们旨在进行一项荟萃分析，以系统评估预防性透析对这些非透析依赖性 CKD 患者的影响。
我们系统地检索了 Medline、Embase、Cochrane 图书馆和其他在线资源，以寻找相关的 RCT。分析了预防性透析对 30 天死亡率和术后并发症发生率的影响。
共纳入 4 项 RCT，纳入患者均接受冠状动脉旁路移植术治疗。术前和术中预防性透析治疗可显著降低 30 天全因死亡率（风险比 [RR]：0.27，95%置信区间 [CI]：0.13-0.58，P<0.001，I2=0%）和肺部并发症发生率（RR：0.39，95%CI：0.20-0.77，P=0.007，I2=0%）、低心输出量（RR：0.29，95%CI：0.09-0.99，P=0.05，I2=0%）和急性肾损伤（RR：0.19，95%CI：0.07-0.52，P=0.001，I2=0%）。然而，透析组和对照组之间在胃肠道出血、脓毒症或多器官衰竭、伤口感染、心律失常、短暂性神经功能缺损、中风和再次出血探查方面无统计学差异。
预防性透析可改善非透析依赖性 CKD 患者心脏手术后 30 天的临床结局，与 30 天死亡率获益相关，并降低肺部并发症、低心输出量和急性肾损伤的发生率。
