不同时机启动肾脏替代治疗对急性肾损伤患者预后影响的Meta分析

Effect of different initiation times for renal replacement therapy on prognosis of acute kidney injury patients:a Meta-analysis

目的探讨不同时机启动肾脏替代治疗(RRT)对急性肾损伤(AKI)患者预后的影响。方法通过检索PubMed/Medline、Embase、Cochrane Library临床试验注册中心3个电子数据库,纳入2000年1月至2018年1月发表的有关不同时机启动RRT对AKI患者预后影响的临床随机对照试验,依据Cochrane系统评价手册进行质量评价,采用RevMan5.3系统软件进行Meta分析,分析早期和晚期行RRT对AKI患者病死率、ICU住院时间及肾脏功能恢复等的影响。结果纳入6项研究,共1298例患者。结果显示,早期RRT组和晚期RRT组总病死率比较差异无统计学意义(OR=1.10,95%CI:0.87~1.39,P=0.44),早期病死率比较差异无统计学意义(OR=1.00,95%CI:0.78~1.28,P=1.00),生存者ICU住院时间比较差异无统计学意义(MD=-0.52,95%CI:-2.60~1.56,P=0.63),生存者肾脏恢复概率比较差异无统计学意义(OR=1.56,95%CI:0.72~3.39,P=0.26)。结论提前启动RRT可能不能改善预后,使患者受益。

Objective To investigate the effect of renal replacement therapy (RRT) initiated at different times on the prognosis of patients with acute kidney injury (AKI).Methods Related randomized controlled trials of RRT initiated at different times published on PubMed,Medline,Embase,and Cochrane Library Clinical Trials from January 2000 to January 2018 were searched.Quality evaluation was evaluated based on Cochrane Systematic Review Manual and RevMan 5.3 system software was used for Meta-analysis.The effect of early and late RRT on AKI patients′ mortality,ICU hospital stays and renal function recovery were analyzed.Results 6 studies including 1298 patients were retrieved and analyzed.There was no significant difference in overall mortality between the early RRT group and the late RRT group ( OR =1.10,95% CI : 0.87 to 1.39,P = 0.44),and early mortality was not significantly different ( OR =1.00,95% CI :0.78 to 1.28,P = 1.00).There was no statistical difference in ICU hospital stays[ MD =-0.52,95% CI :-2.60 to 1.56 , P = 0.63] and no statistical difference in renal function recovery rate among the survivors ( OR =1.56,95% CI : 0.72 to 3.39,P = 0.26).Conclusion Early initiation of RRT may not improve mortality and benefit patients.