Wang Jean Zhuo, Sikora Lindsey, Farrell Peter, Hiremath Swapnil, Clark Edward G
Faculty of Medicine, University of Ottawa, ON, Canada.
Department of Medicine, The Ottawa Hospital, ON, Canada.
Can J Kidney Health Dis. 2025 Jan 7;12:20543581241312631. doi: 10.1177/20543581241312631. eCollection 2025.
Hemodynamic instability related to renal replacement therapy (HIRRT) is a common complication affecting critically ill patients that require renal replacement therapy (RRT). There is currently no consensus regarding the definition of HIRRT in critically ill patients. In this context, the impacts of HIRRT on clinical outcomes such as mortality or renal recovery in critically ill patients are unclear.
The primary objective of this proposed systematic review is to evaluate the association between HIRRT and clinical outcomes, as reported within randomized control trials in the literature. The secondary objective of this systematic review is to compare rates of HIRRT, according to various definitions used by randomized controlled trials, across different RRT modalities used to treat critically ill patients, with the goal of paving the way toward a common definition of HIRRT for future research.
Systematic review and meta-analysis.
The rates of HIRRT, mortality, and renal recovery will be reported according to each definition of HIRRT.
Critically-ill adults with acute kidney injury admitted to intensive care units.
The search strategy will be developed to identify articles in Medline, MEDLINE In-Process, EMBASE, and Cochrane CENTRAL Registry. We will include randomized control trials examining renal replacement therapy in critically ill patients. This will include intermittent hemodialysis (iHD), all forms of prolonged intermittent RRT (PIRRT), and continuous renal replacement therapy (CRRT). Only articles that report a definition of HIRRT and the rates of HIRRT will be included in our analysis. Two reviewers will independently screen all articles for inclusion and exclusion. Data extraction and quality assessment will be also performed in duplicate. All disagreements will be resolved through discussion or a third reviewer.
The heterogeneity in the definitions of HIRRT and outcome reporting may limit the ability to perform meta-analysis and perform comparisons in the rates of HIRRT between RRT modalities.
This systematic review aims to assess the association between HIRRT and important clinical outcomes. In doing so, we will identify definitions of HIRRT within the current literature and the rates of HIRRT associated with these definitions. HIRRT can result in early discontinuation of dialysis, organ injury from hypoperfusion, and may negatively impact mortality and renal recovery in critically ill patients. This systematic review will synthesize the impact and frequency of HIRRT reported in the literature and, in doing so, may help determine the extent to which common definitions of HIRRT might be recommended for standardized use in future research related to HIRRT.
PROSPERO registration number: CRD42023396550.
与肾脏替代治疗相关的血流动力学不稳定（HIRRT）是影响需要肾脏替代治疗（RRT）的危重症患者的常见并发症。目前对于危重症患者中HIRRT的定义尚无共识。在此背景下，HIRRT对危重症患者临床结局（如死亡率或肾脏恢复情况）的影响尚不清楚。
本拟进行的系统评价的主要目的是评估HIRRT与临床结局之间的关联，如文献中随机对照试验所报告的那样。本系统评价的次要目的是根据随机对照试验使用的各种定义，比较用于治疗危重症患者的不同RRT模式下的HIRRT发生率，以期为未来研究中HIRRT的通用定义铺平道路。
系统评价和荟萃分析。
将根据HIRRT的每种定义报告HIRRT发生率、死亡率和肾脏恢复情况。
入住重症监护病房的急性肾损伤危重症成人患者。
将制定检索策略，以识别Medline、MEDLINE In-Process、EMBASE和Cochrane CENTRAL Register中的文章。我们将纳入研究危重症患者肾脏替代治疗的随机对照试验。这将包括间歇性血液透析（iHD）、所有形式的延长间歇性RRT（PIRRT）和连续性肾脏替代治疗（CRRT）。仅报告HIRRT定义和HIRRT发生率的文章将纳入我们的分析。两名评审员将独立筛选所有文章以确定纳入或排除。数据提取和质量评估也将重复进行。所有分歧将通过讨论或第三位评审员解决。
HIRRT定义和结局报告的异质性可能会限制进行荟萃分析以及比较不同RRT模式下HIRRT发生率的能力。
本系统评价旨在评估HIRRT与重要临床结局之间的关联。在此过程中，我们将确定当前文献中HIRRT的定义以及与这些定义相关的HIRRT发生率。HIRRT可能导致透析提前终止、因灌注不足导致器官损伤，并可能对危重症患者的死亡率和肾脏恢复产生负面影响。本系统评价将综合文献中报告的HIRRT的影响和发生率，并可能有助于确定在未来与HIRRT相关的研究中，推荐通用HIRRT定义以供标准化使用的程度。
PROSPERO注册号：CRD42023396550。
