Continuous versus intermittent renal replacement therapy: a meta-analysis
Continuous versus intermittent renal replacement therapy: a meta-analysis
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DOI：
10.1007/s00134-001-1159-4
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发表时间：
2002-01-01
影响因子：
38.9
通讯作者：
Linde-Zwirble, WT
中科院分区：
文献类型：
--
作者：
Kellum, JA;Angus, DC;Linde-Zwirble, WT
目的：危重患者通常会出现急性肾功能衰竭，需要连续肾脏替代疗法（CRRT）或间歇性血液透析（IRRT）形式的机械支持。由于对于大多数危重患者应使用哪种治疗方式存在争议，我们试图确定 CRRT 或 IRRT 是否与更好的生存相关。设计：我们对所有先前比较 CRRT 与 IRRT 的随机和观察性研究进行了荟萃分析。研究是通过 MEDLINE 搜索、作者档案、综述文章参考书目、摘要和科学会议记录来确定的。通过盲法审查对研究的基线特征、干预、结果和整体质量进行了评估。主要终点是医院死亡率，通过累积相对风险（RR）进行评估。测量和结果：我们确定了 13 项研究 (n=1400)，其中只有 3 项是随机的。总体而言，死亡率没有差异（RR 0.93（0.79-1.09），p=0.29）。然而，研究质量很差，只有六项研究在基线（入组时间）比较了相同严重程度的疾病组。调整研究质量和疾病严重程度后，接受 CRRT 治疗的患者死亡率较低（RR 0.72 (0.60-0.87)，p
Objective: Patients with critical illness commonly develop acute renal failure requiring mechanical support in the form of either continuous renal replacement therapy (CRRT) or intermittent hemodialysis (IRRT). As controversy exists regarding which modality should be used for most patients with critically illness,, we, sought to determine whether CRRT or IRRT is associated with better survival. Design: We performed a meta-analysis of all prior randomized and observational studies that compared CRRT with IRRT. Studies were identified through a MEDLINE search, the authors' files, bibliographies of review articles, abstracts and proceedings of scientific meetings. Studies were assessed for baseline characteristics, intervention, outcome and overall quality through blinded review. The primary end-point was hospital mortality, assessed by cumulative relative risk (RR). Measurements and results: We identified 13 studies (n=1400), only three of which were randomized. Overall there was no difference in mortality (RR 0.93 (0.79-1.09), p=0.29). However, study quality was poor and only six studies compared groups of equal severity of illness at baseline (time of enrolment). Adjusting for study quality and severity of illness, mortality was lower in patients treated with CRRT (RR 0.72 (0.60-0.87), p