系统评价和荟萃分析：腹膜透析对终末期糖尿病肾病患者的疗效和安全性。

Systematic review and meta-analysis: the effect and safety of peritoneal dialysis in patients with end-stage diabetic kidney disease.

机构信息

Department of Internal Medicine of Donghu, The Second Affiliated Hospital of Hainan Medical University, Haikou, China.

Department of Nephrology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China.

出版信息

Ann Palliat Med. 2022 Feb;11(2):695-707. doi: 10.21037/apm-22-50.

DOI:10.21037/apm-22-50

PMID:35249347

Abstract

BACKGROUND

At present, peritoneal dialysis (PD) is widely used in the clinical treatment of patients with end-stage renal disease (ESRD), and comparison of the efficacy of PD and hemodialysis (HD) in the treatment of diabetic kidney disease (DKD) has been reported in a few clinical studies.

METHODS

In this study, "dialysis", "peritoneal dialysis", "renal replacement therapy", "end-stage renal disease", "diabetic renal disease", and "efficacy and safety" were used as search terms in Chinese and English databases. According to RevMan 5.3 and Stata 13 software provided by the Cochrane Collaboration, a meta-analysis was performed.

RESULTS

Four randomized controlled trials were included in this study, and 3 trials described the randomization method, 3 described allocation concealment in detail, and 2 used the blinding method. Compared with the HD treatment in the control group, the PD treatment in the experimental group can significantly reduce the hemoglobin of patients with end-stage DKD [Mean difference (MD) =-0.13, 95% confidence interval (CI): -0.21 to -0.04; P=0.003<0.05] and Albumin level (MD = -0.10, 95% CI: -0.16 to -0.04; P=0.002<0.05). Compared with the control group, the PD treatment in the experimental group significantly increased the serum creatinine and blood urea nitrogen levels in patients with end-stage DKD, but there was no significant difference in the effects of PD and HD treatment on serum creatinine levels (MD =-0.30, 95% CI: -0.77 to 0.16; P=0.20>0.05), (MD =1.93, 95% CI: -2.65 to 6.51; P=-0.41>0.05). In addition, PD treatment in the experimental group significantly increased the probability of malignant tumors in patients with end-stage DKD [odds ratio (OR) =1.86, 95% CI: 1.64 to 2.10; P<0.00001], and the difference was significant.

DISCUSSIONS

This study used meta-analysis to confirm that PD can significantly improve the renal function of patients with end-stage DKD, but it can also increase the probability of protein loss and complications.

摘要

背景

目前，腹膜透析（PD）在终末期肾脏疾病（ESRD）患者的临床治疗中得到广泛应用，已有少数临床研究比较了 PD 和血液透析（HD）治疗糖尿病肾病（DKD）的疗效。

方法

本研究中文和英文数据库中使用了“透析”“腹膜透析”“肾脏替代治疗”“终末期肾脏疾病”“糖尿病肾脏疾病”和“疗效和安全性”作为检索词。根据 Cochrane 协作提供的 RevMan 5.3 和 Stata 13 软件，进行了荟萃分析。

结果

本研究纳入了 4 项随机对照试验，其中 3 项描述了随机分组方法，3 项详细描述了分配隐藏，2 项使用了盲法。与对照组的 HD 治疗相比，实验组的 PD 治疗可显著降低终末期 DKD 患者的血红蛋白[均数差（MD）=-0.13，95%置信区间（CI）：-0.21 至-0.04；P=0.003<0.05]和白蛋白水平（MD =-0.10，95% CI：-0.16 至-0.04；P=0.002<0.05）。与对照组相比，实验组的 PD 治疗可显著提高终末期 DKD 患者的血清肌酐和血尿素氮水平，但 PD 和 HD 治疗对血清肌酐水平的影响无显著差异[MD =-0.30，95% CI：-0.77 至 0.16；P=0.20>0.05]，[MD =1.93，95% CI：-2.65 至 6.51；P=-0.41>0.05）。此外，实验组的 PD 治疗可显著增加终末期 DKD 患者恶性肿瘤的发生概率[比值比（OR）=1.86，95% CI：1.64 至 2.10；P<0.00001]，差异有统计学意义。