A systematic review of continuous renal replacement therapy and intermittent haemodialysis in management of patients with acute renal failure
A systematic review of continuous renal replacement therapy and intermittent haemodialysis in management of patients with acute renal failure
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DOI：
10.1111/j.1440-1797.2008.00966.x
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发表时间：
2008-10-01
期刊：
影响因子：
2.5
通讯作者：
Hollenbeak, Christopher
中科院分区：
文献类型：
--
作者：
Ghahramani, Nasrollah;Shadrou, Shahrouz;Hollenbeak, Christopher
背景资料：急性肾功能衰竭（ARF）预后差，死亡率高达70%，肾脏替代治疗（RRT）的理想形式仍存在争议。本研究的目的是对所有随机对照试验（RCT）进行系统回顾和荟萃分析，以检查透析方式的影响（IHD：间歇性血液透析; CRRT：连续性肾脏替代治疗）对ARF患者生存率的影响，并研究每种方式对透析依赖性（DD）的影响。使用并结合两个综合检索主题（ARF和RRT），我们检索了1969年至2007年9月的电子数据库，并补充了对肾脏病学会议摘要和综述文章参考文献列表的手动综述。纳入了所有在成人ARF患者中比较IHD与CRRT并明确报告死亡率的RCT。主要结局是接受CRRT与IHD治疗的ARF患者死亡率比值比（OR）的汇总估计值。次要结局是生存patients.Results：共确定了587项研究，其中554项在初始筛选时被排除在外。对9项RCT（1635例患者）的分析显示，CRRT患者的生存率OR为0.89（0.63-1.24）。将分析限制在2000年以后发表的7个RCT中，显示OR为0.72（0.58-0.90）。2000年以前所有研究的OR为1.06（95%CI 0.67-1.68），而2000年以后研究的OR为0.61（95%CI 0.50-0.74）。4项研究显示CRRT组中DD风险显著降低，没有研究显示DD的OR较高。当分析仅限于RCT时，DD的OR为1.07（0.47-2.39），这表明DD之间没有差异models.Conclusions：类似于先前报道的荟萃分析，我们没有发现CRRT对生存率OR的显著影响。CRRT相对于IHD的生存率OR的进行性降低可能反映了IHD的进行性改善。DD的OR不受RRT模式的影响。总之，与IHD相比，CRRT在ARF的生存率或DD方面没有优势。考虑到其成本和潜在缺点，必须确定可能从CRRT中获得最大获益的ARF患者亚组。这将需要进行大型、充分把握度的研究，并进行充分随访。
Background: Acute renal failure (ARF) still bears a poor prognosis with mortality rates up to 70% and the ideal form of renal replacement therapy (RRT) remains controversial. The purpose of this study was to conduct a systematic review and meta-analysis of all randomized controlled trials (RCT) to examine the effect of dialysis modality (IHD: Intermittent haemodialysis; CRRT: continuous renal replacement therapy) on survival of patients with ARF and to also study the effect of each modality on dialysis dependence (DD).Methods: Using and combining two comprehensive search themes (ARF and RRT), we searched electronic databases from 1969 through September of 2007, supplemented by a manual review of abstracts from nephrology meetings and reference lists of review articles. All RCT comparing IHD with CRRT in adult patients with ARF and with explicit reporting of mortality were included. The primary outcome was the pooled estimate of the odds ratio (OR) of mortality for patients with ARF treated with CRRT versus IHD. The secondary outcome was OR of DD at time of discharge for surviving patients.Results: A total of 587 studies were identified, 554 of which were excluded on initial screening. Analysis of the nine RCT (1635 patients) showed an OR of 0.89 (0.63-1.24) for survival in patients on CRRT. Limiting the analysis to the seven RCT published after the year 2000, revealed an OR of 0.72 (0.58-0.90). The OR of all the studies before 2000 was 1.06 (95% CI 0.67-1.68), as compared with OR of 0.61 (95% CI 0.50-0.74) for studies post-2000. Four studies showed a significantly lower risk of DD among the CRRT group and none showed higher OR for DD. When analysis was limited to the RCT, the OR for DD was 1.07 (0.47-2.39), suggesting no difference in DD between the modalities.Conclusions: Similar to previously reported meta-analyses, we did not find a significant effect of CRRT on the OR of survival. The progressive reduction in the OR of survival with CRRT relative to IHD might reflect progressive improvements in IHD. The OR of DD was not affected by mode of RRT In conclusion, compared with IHD, CRRT does not offer an advantage with regards to survival or DD in ARF. Considering its cost and potential disadvantages, it is imperative to identify the subset of patients with ARF that would potentially derive maximum benefit from CRRT This will require large, adequately powered studies with sufficient follow-up.