中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (11): 795-795-800,807.doi: 10.3969/j.issn.1671-4091.2022.11.003

• 临床研究 • 上一篇    下一篇

肾脏替代治疗启动时机对重症急性肾损伤患者预后影响的Meta分析

成慧昕    杜欣欣    李 祥    杨春波    王 毅    于湘友   

  1. 830054 乌鲁木齐，1新疆医科大学第一附属医院重症医学科
  • 收稿日期:2022-06-13 修回日期:2022-08-17 出版日期:2022-11-11 发布日期:2022-11-12
  • 通讯作者: 于湘友 E-mail:yu2796@163.com
  • 基金资助:
    自治区区域协同创新专项(科技援疆计划)(2021E02064)； 国家自然科学基金（82160360）

Timing of renal replacement therapy initiation for critically ill patients with acute kidney injury--a meta-analysis 

CHENG Hui-xin, DU Xin-xin, LI Xiang, YANG Chun-bo, WANG Yi, YU Xiang-you   

  1. Department of Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Urumqi  830054, China 
  • Received:2022-06-13 Revised:2022-08-17 Online:2022-11-11 Published:2022-11-12
  • Contact: 830054 乌鲁木齐，1新疆医科大学第一附属医院重症医学科 E-mail:yu2796@163.com

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摘要： 目的  本研究旨在评价肾脏替代治疗(renal replacement therapy, RRT)的启动时机对重症急性肾损伤患者预后的影响。方法  检索PubMed、Web of Science、Embase、中国知网、万方数据知识服务平台、维普等数据库中有关肾脏替代治疗的不同启动时机对重症急性肾损伤患者影响的相关文献，检索时间限定为建库至2021年12月30日，文章类型限定为随机对照研究(randomized controlled study,RCT)。文献筛选、数据提取由2名研究者独立完成，主要结局指标为28天死亡率，次要结局指标为90天肾脏替代治疗需求以及相关并发症发生情况等，采用RevMan 5.3软件进行Meta分析，使用Cochrane偏倚风险工具评估偏倚风险。 结果 共纳入RCT 15篇，5709例重症患者，其中早期启动组2851例，晚期启动组2858例。Meta分析结果显示：早期启动组与晚期启动组死亡率差异无统计学意义(OR=0.96，95%CI：0.86～1.08，P=0.49)。晚期启动可以降低90天内患者对RRT的依赖(OR=1.57，95%CI：1.13～2.19，P＜0.05)，同时也可降低患者导管相关性血流感染(catheter related blood stream infection,CRBSI)、RRT相关性低血压及低磷血症的发生风险(CRBSI:OR =1.44，95%CI：1.06～1.95，P=0.02；低血压：OR=1.43，95%CI：1.17～1.76 P＜0.05；低磷血症：OR=1.85 95%CI=1.02～3.35，P =0.04)。 结论 早期启动RRT不能降低重症急性肾损伤患者的死亡率，晚期启动RRT可以降低患者90天内对RRT的依赖并减少相关并发症的发生风险。

关键词: 肾脏替代治疗, 急性肾损伤, 启动时机

Abstract: ackground  This study aimed to evaluate the impact of timing of renal replacement therapy (RRT) on prognosis in patients with severe acute kidney injury.  Methods  PubMed, Web of Science, Em-base, CNKI, Wanfang Data Knowledge Service platform, VIP and other databases were searched for literatures related to the influence of different start-up times of renal replacement therapy on patients with severe and complicated acute kidney injury. The retrieval time was limited to create database to December 30, 2021. The article type was limited to randomized controlled study (RCT). Literature screening and data extraction were independently completed by two researchers. The main outcome indicators were 28-day mortality, and the secondary outcome indicators were the need for renal replacement therapy at 90 days and the incidence of related complications. Meta-analysis was performed using RevMan 5.3 software. The Cochrane Risk of Bias Tool was used to assess the risk of bias in all studies.  Results  A total of 5709 severe patients were included in 15 RCTS in this study, including 2851 patients in the early initiation group and 2858 patients in the late initiation group. Meta-analysis showed that there was no significant difference in mortality between the early and late initiation groups [odds ratio (OR) = 0.96, 95%confidence interval (95% CI: 0.86～1.08, P =0.49]. Late initiation reduced RRT dependence within 90 days (OR=1.57, 95% CI:1.13～2.19, P ＜0.05), and the risk of catheter related blood stream infection (CRBSI), RRT-associated hypotension, and hypophosphatemia. (CRBSI:OR=1.4495%, CI:1.06～1.95, P =0.02; Hypotension: OR=1.4395% CI:1.17～1.76, P ＜0.05; Hypophosphatemia: OR=1.85, 95% CI:1.02～3.35, P =0.04).  Conclusions  Early RRT initiation does not reduce mortality in patients with severe AKI, but late RRT initiation can reduce RRT dependence within 90 days and the risk of related complications. 

Key words: Renal replacement therapy, Acute kidney injury；Initiation

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