艾考糊精腹膜透析液的快速卫生技术评估

Rapid Health Technology Assessment of Icodextrin Peritoneal Dialysate

目的:基于快速卫生技术评估(HTA)的方法,评价艾考糊精腹膜透析液的有效性、安全性和经济性,为临床用药决策提供循证医学证据。方法:检索PubMed、Embase、the Cochrane Library、中国知网、万方数据库和HTA机构官方网站等数据库(检索时限为建库至2022年6月),纳入艾考糊精腹膜透析液相关的HTA报告、系统评价/Meta分析和药物经济学研究。根据纳入与排除标准,由2名研究者独立进行文献筛选、质量评价和数据提取,并对数据结果进行定性分析。结果:共纳入6篇系统评价/Meta分析和1篇经济学研究。(1)有效性,与葡萄糖腹膜透析液相比,艾考糊精腹膜透析液在长时间留腹期间能够显著提高患者超滤量和腹膜尿素清除率,降低游离脂肪酸水平,并且能够降低患者超滤失败风险。(2)安全性,艾考糊精腹膜透析液在腹膜透析相关腹膜炎发生率和总不良反应发生率等安全性指标方面,不劣于葡萄糖腹膜透析液。(3)经济性,艾考糊精腹膜透析液在能够推迟患者由腹膜透析转入血液透析时间的前提下,具有经济性。结论:艾考糊精腹膜透析液应用于腹膜透析患者的临床治疗具有良好的有效性、安全性,但是否具有经济性还需开展更多的相关研究。

OBJECTIVE:To evaluate the efficacy,safety and economy of icodextrin peritoneal dialysate based on rapid health technology assessment(HTA),so as to provide evidence-based medical-evidence information for clinical decision-makers.METHODS:PubMed,Embase,the Cochrane Library,CNKI,Wanfang Data and the official website of HTA institutions were searched systematically(the retrieval time was from the establishment of the database to Jun.2022)to collect HTA reports,systematic review/Meta-analysis,and pharmacoeconomic studies related to icodextrin peritoneal dialysate.According to inclusion and exclusion criteria,two researchers independently screened articles,evaluated quality and extracted data,and qualitative analysis was performed on the data results.RESULTS:A total of 6 systematic review/Meta-analysis and 1 economic study were included.(1)In terms of effectiveness,compared with glucose peritoneal dialysis liquid,icodextrin peritoneal dialysate could significantly increase the ultrafiltration volume and peritoneal urea clearance rate,reduce free fatty acids and reduce the risk of ultrafiltration failure in patients during prolonged abdominal retention.(2)In terms of safety,the incidence of peritonitis associated with peritoneal dialysis and the incidence of total adverse drug reactions were not inferior to those of icodextrin peritoneal dialysate.(3)In terms of economics,icodextrin peritoneal dialysate was economical under the premise that it could delay the time of patients transferring from peritoneal dialysis to hemodialysis.CONCLUSIONS:Icodextrin peritoneal dialysate has good efficacy and safety in clinical treatment of peritoneal dialysis patients,but whether it is economic needs more relevant studies.