RRT时机对急性肾损伤病人预后影响的Meta分析

EFFECTS OF TIMING OF RENAL REPLACEMENT THERAPY ON OUTCOMES IN PATIENTS WITH ACUTE KIDNEY INJURY:A META ANALYSIS

目的 探讨肾脏替代治疗（RRT）时机对急性肾损伤危重症病人预后的影响,比较早期与晚期RRT的差异。方法 在中国生物医学文献数据库、维普、万方及中国期刊全文数据库中进行相关检索。评价筛选肾损伤危重症病人RRT时机的队列研究和随机对照试验（RCT）,进行Meta分析。结果 7项研究符合纳入标准。与晚期RRT组相比,早期RRT组可降低病死率（OR=0.15,95%CI=0.08~0.27）。各研究间存在显著的异质性（I2=53.5%）。根据病人入住ICU的类型（是否仅为外科）、APACHEⅡ评分及血肌酐、血清尿素氮水平等分组后分析,并未发现影响病死率总的结果。与晚期RRT组比较,早期RRT组未显著降低脱离RRT率。其中有1项研究显示早期RRT组可减少RRT持续时间,缩短住ICU时间。结论 早期对急性肾损伤危重症病人行RRT能改善其预后。但是此结论是基于各种不同质量的异质性研究,缺乏大规模的RCT,仍不能作为确定治疗的标准。

Objective To investigate the effects of timing of renal replacement therapy （RRT） on outcomes in critically ill patients with acute kidney injury （AKI） and compare the differences between the early and late RRT. Methods CBM, VIP, Wanfang Data, CNKI and other sources were searched. Eligible studies selected were cohort and randomized trials that assessed timing of initiation of RRT in critically ill patients with AKI. Results Seven eligible studies were identified. Compared with late RRT, the early RRT decreased mortality （OR = 0.15;95% CI = 0.08- 0.27）. There was a significant heterogeneity among the studies （12 = 53.5 % ）. In subgroup analyses, stratifying by patient population （only surgical or not）, Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ ）, creatinine and urea, there was no impact on the overall mortality. Compared with late RRT showed that early RRT did not significantly affect the odds of dialysis free, in which, one of its items showed early RRT could shorten the duration of RRT and ICU staying. Conclusion Early renal replacement therapy in critically ill patients with acute renal injury can improve the patient＇s prognosis. This conclusion, however, is based on heterogeneous studies of variable quality lacking of large-scale randomized controlled trials, which is still not considered as determined standard of treatment.