高通量和低通量透析对维持性血液透析患者生存率影响的Meta分析

Effect of high-flux and low-flux hemodialysis on survival rate of maintenance hemodialysis patients:A Meta analysis

目的比较高通量血液透析(high flux hemodialysis,HFHD)与低通量血液透析(1ow flux hemodialysis,LFHD)对于维持性血液透析(maintenance hemodialysis,MHD)患者生存率的影响。方法计算机检索Cochrana Library、PubMed、EMBACE、CNKI、万方数据库、维普数据库,查找所有比较HFHD和LFHD对于MHD患者生存率的随机对照试验和前瞻性对照试验,检索时限为建库至2016年3月1日。按纳入排除标准由系统评价员独立进行资料提取和质量评价后,采用RevMan 5.2软件进行Meta分析。结果共8项研究,8 561例患者被纳入本次研究。对于MHD患者,HFHD比LFHD具有更高的长期生存率[HR=0.71,95%CI:(0.63,0.8),P<0.05],进一步的亚组分析显示,无论随访时间大于3年或是小于3年,HFHD患者的全因病死率均低于LFHD患者(P<0.05)。在总体血液透析患者中,因心血管疾病死亡的发生率高于因感染而死亡的患者(P<0.05),且HFHD患者心血管病死率比LFHD患者病死率低[OR=0.79,95%CI:(0.65,0.96),P=0.02],而HFHD和LFHD患者的感染病死率没有统计学差异[OR=0.90,95%CI:(0.69,1.18),P=0.45]。结论对于MHD患者,合理使用HFHD可提高其长期生存率,降低心血管疾病病死率。

Objective To compare the impact of high-flux hemodialysis （HFHD） and low-flux hemodialysis （LFHD） on survival rate of maintenance hemodialysis （MHD） patients. Methods We searched Cochrane Library, PubMed, Embase, CNKI, Wanfang data and VIP from the establishment of the database to March 1, 2016 to identify random controlled trials （RCT） and prospective controlled trials （PCT） on the impact of HFHD and LFHD on survival rate of MHD patients. The quality of the selected trials was appraised and the data were extracted according to the inclusion and exclusion criteria. RevMan 5. 2 software was used for the Meta analysis. Results Eight researches involving 8 561 patients were included in this study. The Meta analysis found that in MHD patients, HFHD patients had higher long-term survival rate than LFHD patients EHR = 0. 71, 95% CI： （0. 63, 0. 8）, P〈 0. 051. In further subgroup analysis, it was found that HFHD patients had lower all-cause mortality （ACM） （P〈0. 05） no matter the follow-up period was longer than 3 years or not. In MHD patients, the cardiovascular mortality was higher than the incidence of death caused by infection （P〈0. 05）. As compared with the LFHD patients, HFHD patients had lower cardiovascular mortality [-OR = 0. 79, 95% CI： （0. 65, 0. 96）, P = 0.02]. No difference was found in infection-associated mortality between HFHD and LFHD patients [OR= 0. 90, 95% CI： （0. 69, 1.18）, P = 0. 45]. Conclusions Based on this Meta analysis, HFHD can improve the long-term survival rate in MHD patients and reduce cardiovascular mortality.