Hussain Salman, Singh Ambrish, Antony Benny, Claure-Del Granado Rolando, Klugarová Jitka, Líčeník Radim, Klugar Miloslav
Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre Cochrane, Czech Republic), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic.
Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000, Australia.
J Clin Med. 2021 Sep 26;10(19):4390. doi: 10.3390/jcm10194390.
Acute kidney injury (AKI) is associated with several adverse outcomes, including new or progressive chronic kidney disease, end-stage kidney disease, and mortality. Epidemiological studies have reported an association between AKI and dementia as a long-term adverse outcome. This meta-analysis was aimed to understand the association between AKI and dementia risk. A literature search was performed in MEDLINE and Embase databases, from inception to July 2021, to identify epidemiological studies reporting the association between AKI and dementia risk. Title and abstract followed by the full-text of retrieved articles were screened, data were extracted, and quality was assessed, using the Newcastle-Ottawa scale by two investigators independently. The primary outcome was to compute the pooled risk of dementia in AKI patients. Subgroup analysis was also performed based on age and co-morbidities. Certainty of evidence was assessed using the GRADE approach. Statistical analysis was performed using Review Manager 5.4 software. Four studies (cohort ( = 3) and case-control ( = 1)) with a total of 429,211 patients, of which 211,749 had AKI, were identified. The mean age of the patients and the follow-up period were 64.15 ± 16.09 years and 8.9 years, respectively. Included studies were of moderate to high quality. The pooled estimate revealed a significantly higher risk of dementia in AKI patients with an overall relative risk/risk ratio (RR) of 1.92 (95% CI: 1.52-2.43), ≤ 0.00001. Dementia risk increases by 10% with one year increase in age with an RR of 1.10 (95% CI: 1.09-1.11), < 0.00001. Subgroup analysis based on stroke as a co-morbid condition also revealed significantly higher dementia risk in AKI patients (RR 2.30 (95% CI: 1.62-3.28), = 0.009). All-cause mortality risk was also significantly higher in AKI patients with dementia with a pooled RR of 2.11 (95% CI: 1.20-3.70), = 0.009. The strength of the evidence was of very low certainty as per the GRADE assessment. Patients with AKI have a higher risk of dementia. Further large epidemiological studies are needed to confirm the mechanistic association.
急性肾损伤（AKI）与多种不良后果相关，包括新发或进展性慢性肾脏病、终末期肾病和死亡。流行病学研究报告了AKI与痴呆作为一种长期不良后果之间的关联。本荟萃分析旨在了解AKI与痴呆风险之间的关联。在MEDLINE和Embase数据库中进行了从建库至2021年7月的文献检索，以识别报告AKI与痴呆风险之间关联的流行病学研究。由两名研究者独立使用纽卡斯尔-渥太华量表对检索文章的标题、摘要及全文进行筛选、提取数据并评估质量。主要结局是计算AKI患者痴呆的合并风险。还根据年龄和合并症进行了亚组分析。使用GRADE方法评估证据的确定性。使用Review Manager 5.4软件进行统计分析。共纳入4项研究（队列研究（n = 3）和病例对照研究（n = 1）），总计429,211例患者，其中211,749例患有AKI。患者的平均年龄和随访时间分别为64.15±16.09岁和8.9年。纳入的研究质量为中等至高。汇总估计显示，AKI患者患痴呆的风险显著更高，总体相对风险/风险比（RR）为1.92（95%CI：1.52 - 2.43），P≤0.00001。年龄每增加1岁，痴呆风险增加10%，RR为1.10（95%CI：1.09 - 1.11），P<0.00001。以中风作为合并症的亚组分析也显示，AKI患者患痴呆的风险显著更高（RR 2.30（95%CI：1.62 - 3.28），P = 0.009）。AKI合并痴呆患者的全因死亡风险也显著更高，汇总RR为2.11（95%CI：1.20 - 3.70），P = 0.009。根据GRADE评估，证据的强度确定性很低。AKI患者患痴呆的风险更高。需要进一步的大型流行病学研究来证实其机制关联。
