| 肾脏替代治疗启动时机对成人急性肾损伤患者预后影响的Meta分析 |
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| 引用本文： | 徐冬雪,蒋芳,张晓艺,柳叶,彭志勇. 肾脏替代治疗启动时机对成人急性肾损伤患者预后影响的Meta分析[J]. 中华危重症医学杂志(电子版), 2020, 13(5): 356-363. DOI: 10.3877/cma.j.issn.1674-6880.2020.05.007 |
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| 作者姓名： | 徐冬雪 蒋芳 张晓艺 柳叶 彭志勇 |
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| 作者单位： | 1. 430071 武汉，武汉大学中南医院重症医学科 |
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| 基金项目： | 国家自然科学基金项目(81772046); 湖北省科技计划项目(2017AHB044) |
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| 摘 要： | 目的系统评估启用肾脏替代治疗（RRT）时机对成人急性肾损伤（AKI）患者预后的影响。 方法计算机检索PubMed、The Cochrane Library、Embase数据库从建库至2019年2月发表的关于成人AKI患者启用RRT时机的临床随机对照研究（RCT）。由2位研究者按照纳入及排除标准独立进行文献筛选、资料提取及质量评价，采用Revman 5.3软件进行Meta分析。 结果共纳入11个RCT，包括2 332例AKI患者。Meta分析显示，早期与晚期启动RRT治疗的AKI患者间总病死率[相对危险度（RR）= 0.92，95%置信区间（CI）（0.78，1.09），Z = 5.53，P = 0.35]、14 d病死率[RR = 0.84，95%CI（0.66，1.07），Z = 1.40，P = 0.16]、30 d病死率[RR = 0.98，95%CI（0.83，1.10），Z = 0.40，P = 0.69]、60 d病死率[RR = 0.97，95%CI（0.87，1.07），Z = 0.67，P = 0.50]、90 d病死率[RR = 1.00，95%CI（0.89，1.12），Z = 0.01，P = 0.99]、ICU住院时间[标准均数差（SMD）= -0.08，95%CI（-0.18，0.02），Z = 1.63，P = 0.10]以及总住院时间[SMD = -0.16，95%CI（-0.32，0.00），Z = 1.96，P = 0.05]的比较，差异均无统计学意义。 结论早期RRT治疗不能改善成人AKI患者的预后。
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| 关 键 词： | 急性肾损伤 肾脏替代治疗 启动时机 预后 Meta分析 |
| 收稿时间： | 2020-09-19 |
Effect of renal replacement therapy timing on prognosis of adult patients with acute kidney injury: a meta-analysis |
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| Dongxue Xu,Fang Jiang,Xiaoyi Zhang,Ye Liu,Zhiyong Peng. Effect of renal replacement therapy timing on prognosis of adult patients with acute kidney injury: a meta-analysis[J]. Chinese Journal of Critical Care Medicine ( Electronic Editon), 2020, 13(5): 356-363. DOI: 10.3877/cma.j.issn.1674-6880.2020.05.007 |
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| Authors: | Dongxue Xu Fang Jiang Xiaoyi Zhang Ye Liu Zhiyong Peng |
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| Affiliation: | 1. Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China |
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| Abstract: | ObjectiveTo evaluate the effect of renal replacement therapy (RRT) timing on the prognosis of adult patients with acute kidney injury (AKI). MethodsSystematic searches were conducted in the PubMed, Cochrane Library and Embase database to collect randomized controlled trials (RCTs) about the early and delayed initiation of RRT for adult patients with AKI published up to February 2019. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. Meta-analysis was conducted using the Revman 5.3 software. ResultsEleven RCTs involving 2 332 AKI patients were enrolled. Meta-analysis demonstrated that the total mortality [risk ratio (RR) = 0.92, 95% confidence interval (CI) (0.78, 1.09), Z = 5.53, P = 0.35], 14 d mortality [RR = 0.84, 95%CI (0.66, 1.07), Z = 1.40, P = 0.16], 30 d mortality [RR = 0.98, 95%CI (0.83, 1.10) , Z = 0.40, P = 0.69], 60 d mortality [RR = 0.97, 95%CI (0.87, 1.07), Z = 0.67, P = 0.50], 90 d mortality [RR = 1.00, 95%CI (0.89, 1.12), Z = 0.01, P = 0.99], ICU stay[standardized mean difference (SMD) = -0.08, 95%CI (-0.18, 0.02), Z = 1.63, P = 0.10] and hospital stay [SMD = -0.16, 95%CI (-0.32, 0.00), Z = 1.96, P = 0.05] were not significantly different between AKI patients with the early and delayed initiation of RRT. ConclusionEarly initiation of RRT cannot improve the prognosis of adult patients with AKI. |
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| Keywords: | Acute kidney injury Renal replacement therapy Timing Prognosis Meta-analysis |
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