Martimbianco Ana Luiza Cabrera, Moreira Roberta de Fátima Carreira, Pacheco Rafael Leite, Latorraca Carolina de Oliveira Cruz, Dos Santos Ana Paula Pires, Logullo Patrícia, Riera Rachel
Núcleo de Ensino e Pesquisa e Saúde Baseada em Evidências e Avaliação de Tecnologias em Saúde (NEP-SBEATS), Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês (NATS-HSL), São Paulo, SP, Brazil.
Semin Dial. 2023 Jan;36(1):3-11. doi: 10.1111/sdi.13120. Epub 2022 Aug 7.
Pregnancy in chronic kidney disease (CKD) women is relatively rare, and the less risky choice of hemodialysis is unknown. The objective of this systematic review was to identify, systematically evaluate and summarize the available evidence on the efficacy and safety of hemodialysis strategies for pregnant CKD women. Sensitive search strategies were applied to six databases without data or language restrictions. Comparative (randomized and non-randomized) studies were prioritized. Two reviewers independently selected, extracted, and critically evaluated data from studies. The risk of bias assessment was performed using the ROBINS-I tool, considering the study design (non-randomized comparative observational studies). The certainty of the evidence was assessed using the GRADE approach. From 7210 references identified, six retrospective cohort studies were included (576 women). The effects of intensive hemodialysis (over 20 h/week) are uncertain for maternal and neonatal mortality (Peto odds ratio [OR] 0.85; 95% confidence interval [95% CI] 0.26-2.80), miscarriage (Peto OR 0, 38; 95% CI 0.12-1.23), stillbirths (Peto OR 0, 56; 95% CI 0.13-2.31), preterm birth (Peto OR 0.87; 95% CI 0.33-2.28), low birth weight (Peto OR 0.71; 95% CI 0.20-2.50) and congenital anomalies rates. The certainty of the evidence was very low due to studies methodological limitations and effect estimates imprecision. The uncertainty about intensive versus conventional hemodialysis effects for pregnant women with CKD and the imprecision in the estimated effects precludes any recommendation. The strategy choice must consider treatment availability, costs, and maternal social aspects until future studies provide more reliable evidence. PROSPERO CRD42021259237.
慢性肾脏病（CKD）女性怀孕相对少见，而血液透析风险较低的选择尚不清楚。本系统评价的目的是识别、系统评价和总结关于怀孕CKD女性血液透析策略有效性和安全性的现有证据。对六个数据库应用了敏感的检索策略，无数据或语言限制。优先纳入比较性（随机和非随机）研究。两名评价员独立从研究中选择、提取并严格评价数据。使用ROBINS-I工具进行偏倚风险评估，考虑研究设计（非随机比较观察性研究）。使用GRADE方法评估证据的确定性。从识别出的7210篇参考文献中，纳入了六项回顾性队列研究（576名女性）。强化血液透析（每周超过20小时）对孕产妇和新生儿死亡率（Peto比值比[OR]0.85；95%置信区间[95%CI]0.26-2.80）、流产（Peto OR 0.38；95%CI 0.12-1.23）、死产（Peto OR 0.56；95%CI 0.13-2.31）、早产（Peto OR 0.87；95%CI 0.33-2.28）、低出生体重（Peto OR 0.71；95%CI 0.20-图2.50）和先天性异常率的影响尚不确定。由于研究方法的局限性和效应估计的不精确性，证据的确定性非常低。对于怀孕CKD女性，强化血液透析与传统血液透析效果的不确定性以及估计效应的不精确性使得无法给出任何推荐。在未来研究提供更可靠的证据之前，策略选择必须考虑治疗的可及性、成本和产妇的社会因素。国际前瞻性系统评价注册库CRD42021259237。
