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

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。

Effect of renal replacement therapy timing on prognosis of adult patients with acute kidney injury: a meta-analysis

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 staystandardized 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.