Protection of remote ischemic preconditioning against acute kidney injury: a systematic review and meta-analysis.
Protection of remote ischemic preconditioning against acute kidney injury: a systematic review and meta-analysis.
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远程缺血预处理对急性肾损伤的保护：系统评价和荟萃分析
DOI：
10.1186/s13054-016-1272-y
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发表时间：
2016-04-20
期刊：
影响因子：
--
通讯作者：
Ding X
中科院分区：
文献类型：
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作者：
Hu J;Liu S;Jia P;Xu X;Song N;Zhang T;Chen R;Ding X
远程缺血预适应(RIPC)是预防急性肾损伤(AKI)的一种有前景的方法，但其疗效存在争议。方法系统回顾30项随机对照试验，研究RIPC对AKI发生率和预后的影响。随机效应模型元分析和元回归被用于生成汇总估计和探索异质性的来源。结果RIPC组急性肾损伤的总发生率为11.5%，明显低于对照组的23.3%(P= 0.009)。亚组分析显示，RIPC能显著降低急性心肌梗死(CI-AKI)亚组的发生率，从13.5%降至6.5%(P= 0.000)，但对缺血再灌注组(IR-AKI)无明显影响(从29.5%降至24.7%，P= 0.173)。随机效应Meta回归显示，在糖尿病比例较高的试验中，RIPC倾向于加强其肾脏保护作用(Q= 3.95，df= 1，P= 0.047)。RIPC对1-3期AKI或肾脏替代治疗的发生率、血肌酐变化和估计的肾小球滤过率(EGFR)、住院或30天死亡率或住院时间没有显著影响。但RIPC组与对照组相比，IR-AKI亚组的最小EGFR值显著增加(P= 0.006)。RIPC组ICU住院天数明显少于对照组(2.6vs2.0d，P= 0.003)。结论RIPC可预防脑梗塞，但不能预防胰岛素抵抗。
BackgroundRemote ischemic preconditioning (RIPC) is a promising approach to preventing acute kidney injury (AKI), but its efficacy is controversial.MethodsA systematic review of 30 randomized controlled trials was conducted to investigate the effects of RIPC on the incidence and outcomes of AKI. Random effects model meta-analyses and meta-regressions were used to generate summary estimates and explore sources of heterogeneity. The primary outcome was incidence of AKI and hospital mortality.ResultsThe total pooled incidence of AKI in the RIPC group was 11.5 %, significantly less than the 23.3 % incidence in the control group (P= 0.009). Subgroup analyses indicated that RIPC significantly reduced the incidence of AKI in the contrast-induced AKI (CI-AKI) subgroup from 13.5 % to 6.5 % (P= 0.000), but not in the ischemia/reperfusion-induced AKI (IR-AKI) subgroup (from 29.5 % to 24.7 %,P= 0.173). Random effects meta-regression indicated that RIPC tended to strengthen its renoprotective effect (q= 3.95,df= 1,P= 0.047) in these trials with a higher percentage of diabetes mellitus. RIPC had no significant effect on the incidence of stages 1–3 AKI or renal replacement therapy, change in serum creatinine and estimated glomerular filtration rate (eGFR), hospital or 30-day mortality, or length of hospital stay. But RIPC significantly increased the minimum eGFR in the IR-AKI subgroup (P= 0.006) compared with the control group. In addition, the length of ICU stay in the RIPC group was significantly shorter than in the control group (2.6 vs 2.0 days,P= 0.003).ConclusionsWe found strong evidence to support the application of RIPC to prevent CI-AKI, but not IR-AKI.