Kulkarni Manjunath, Prabhu Attur Ravindra, Rao Indu Ramachandra, Nagaraju Shankar Prasad
Department of Nephrology, Father Muller Medical College, Mangaluru, India.
Department of Nephrology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India.
Cochrane Database Syst Rev. 2024 May 22;5(5):CD015526. doi: 10.1002/14651858.CD015526.pub2.
Dialysis dysequilibrium syndrome (DDS) refers to neurological symptoms usually seen during or after new initiation or following reinitiation of haemodialysis (HD) after missing multiple sessions. DDS is associated with death and morbidity. We studied interventions aimed at preventing DDS.
To evaluate the benefits and harms of different types of interventions for preventing DDS.
We contacted the information specialist and searched the Cochrane Kidney and Transplant Register of Studies up to 8 May 2024 using search terms relevant to this review. Studies in the Register were identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov.
We included randomised controlled trials (RCTs) that compared any intervention against standard care, including individuals initiated on HD, regardless of age.
Two authors independently determined study eligibility, assessed quality and extracted data. Data were collected on methods, interventions, participants, and outcomes (DDS incidence, severe DDS, death, adverse events). Risk ratios (RR) and confidence intervals (CI) were calculated. Study quality was assessed using the Cochrane Risk of Bias 2 (ROB2) tool. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
We included two RCTs, enrolling 32 adult participants. Interventions included were slow dialysis, sodium modelling, standard sodium dialysate, and high sodium dialysate. The risk of bias was of some concern to high risk of bias in both studies. Slow dialysis compared to sodium modelling (1 study, 15 participants) may result in little to no difference in DDS, severe DDS, and death (low certainty evidence) and has uncertain effects on adverse events (RR 1.33, 95% CI 0.15 to 11.64; very low certainty evidence). Standard sodium dialysate compared to high sodium dialysate (1 study, 17 participants) has uncertain effects on the incidence of DDS (RR 0.07, 95% CI 0.00 to 1.12), severe DDS (RR 0.47, 95% CI 0.02 to 10.32), and adverse events (RR 0.29, 95% CI 0.08 to 1.02) (very low certainty evidence).
AUTHORS' CONCLUSIONS: In HD patients, sodium modelling, compared to slow dialysis, may result in little to no difference in DDS and death (low certainty evidence) and has uncertain effects on adverse events (very low certainty evidence). The evidence is very uncertain for the effect of high-sodium dialysate and standard sodium dialysate on DDS, death and adverse events (very low certainty evidence).
透析失衡综合征（DDS）是指在首次开始血液透析（HD）期间或之后，或在错过多次透析后重新开始HD时常见的神经系统症状。DDS与死亡和发病相关。我们研究了旨在预防DDS的干预措施。
评估不同类型干预措施预防DDS的利弊。
我们联系了信息专家，并使用与本综述相关的检索词，检索了截至2024年5月8日的Cochrane肾脏与移植研究注册库。注册库中的研究通过检索CENTRAL、MEDLINE、EMBASE、会议论文集、国际临床试验注册平台（ICTRP）检索门户和ClinicalTrials.gov来识别。
我们纳入了比较任何干预措施与标准护理的随机对照试验（RCT），包括开始HD的个体，无论年龄大小。
两位作者独立确定研究的合格性，评估质量并提取数据。收集了关于方法、干预措施、参与者和结局（DDS发生率、严重DDS、死亡、不良事件）的数据。计算了风险比（RR）和置信区间（CI）。使用Cochrane偏倚风险2（ROB2）工具评估研究质量。使用推荐分级评估、制定和评价（GRADE）方法评估证据的可信度。
我们纳入了两项RCT，共32名成年参与者。纳入的干预措施包括缓慢透析、钠模型化、标准钠透析液和高钠透析液。两项研究的偏倚风险均为高风险，令人有些担忧。与钠模型化相比（1项研究，15名参与者），缓慢透析在DDS、严重DDS和死亡方面可能几乎没有差异（低确定性证据），对不良事件的影响尚不确定（RR 1.33，95%CI 0.15至11.64；极低确定性证据）。与高钠透析液相比，标准钠透析液对DDS发生率（RR 0.07，95%CI 0.00至1.12）、严重DDS（RR 0.47，95%CI 0.02至10.32）和不良事件（RR 0.29，95%CI 0.08至1.02）的影响尚不确定（极低确定性证据）。
在HD患者中，与缓慢透析相比，钠模型化在DDS和死亡方面可能几乎没有差异（低确定性证据），对不良事件的影响尚不确定（极低确定性证据）。高钠透析液和标准钠透析液对DDS、死亡和不良事件的影响证据非常不确定（极低确定性证据）。
