A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis.
A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis.
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DOI：
10.1186/cc10061
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Bagshaw SM
中科院分区：
文献类型：
--
作者：
Karvellas CJ;Farhat MR;Sajjad I;Mogensen SS;Leung AA;Wald R;Bagshaw SM
我们的目的是研究早期和晚期开始肾脏替代治疗（RRT）对急性肾损伤（AKI）危重患者临床结果的影响。本研究采用系统评价和荟萃分析。2010年7月检索了PUBMED、EMBASE、SCOPUS、Web of Science和Cochrane Central Registry of Controlled Clinical Trials等来源。入选的符合条件的研究是评估急性肾损伤危重成人开始RRT时间的队列和随机试验。我们从1494个引用中确定了15个独特的研究（2个随机，4个前瞻性队列，9个回顾性队列）。整体的方法学质量较低。与晚期治疗相比，早期治疗与28天死亡率的显著改善相关(优势比（OR） 0.45；95%置信区间（CI）， 0.28 ~ 0.72)。15项纳入的研究存在显著的异质性（I2 = 78%）。在亚组分析中，按患者群体（手术组，n = 8 vs混合组，n = 7）或研究设计（前瞻性组，n = 10 vs回顾性组，n = 5）进行分层，对死亡率的总体汇总估计没有影响。meta回归控制疾病严重程度（急性生理和慢性健康评估II (APACHE II)），基线肌酐和尿素不影响死亡率的总体汇总估计。在报告次要结果的研究中，7项研究中有5项报告肾脏恢复较好，8项研究中有7项显示RRT持续时间缩短，6项研究中有5项显示与晚期RRT组相比，早期RRT组的ICU住院时间缩短。早期的RRT没有；然而，显著影响住院后透析依赖的几率（OR 0.62 0.34至1.13,I2 = 69.6%）。急性肾损伤危重患者尽早实施RRT可能对生存率有有益影响。然而，这一结论是基于不同质量的异质性研究和两项随机试验。由于缺乏设计合适的随机试验的新证据，因此无法提出明确的治疗建议。
Our aim was to investigate the impact of early versus late initiation of renal replacement therapy (RRT) on clinical outcomes in critically ill patients with acute kidney injury (AKI). Systematic review and meta-analysis were used in this study. PUBMED, EMBASE, SCOPUS, Web of Science and Cochrane Central Registry of Controlled Clinical Trials, and other sources were searched in July 2010. Eligible studies selected were cohort and randomised trials that assessed timing of initiation of RRT in critically ill adults with AKI. We identified 15 unique studies (2 randomised, 4 prospective cohort, 9 retrospective cohort) out of 1,494 citations. The overall methodological quality was low. Early, compared with late therapy, was associated with a significant improvement in 28-day mortality (odds ratio (OR) 0.45; 95% confidence interval (CI), 0.28 to 0.72). There was significant heterogeneity among the 15 pooled studies (I2 = 78%). In subgroup analyses, stratifying by patient population (surgical, n = 8 vs. mixed, n = 7) or study design (prospective, n = 10 vs. retrospective, n = 5), there was no impact on the overall summary estimate for mortality. Meta-regression controlling for illness severity (Acute Physiology And Chronic Health Evaluation II (APACHE II)), baseline creatinine and urea did not impact the overall summary estimate for mortality. Of studies reporting secondary outcomes, five studies (out of seven) reported greater renal recovery, seven (out of eight) studies showed decreased duration of RRT and five (out of six) studies showed decreased ICU length of stay in the early, compared with late, RRT group. Early RRT did not; however, significantly affect the odds of dialysis dependence beyond hospitalization (OR 0.62 0.34 to 1.13, I2 = 69.6%). Earlier institution of RRT in critically ill patients with AKI may have a beneficial impact on survival. However, this conclusion is based on heterogeneous studies of variable quality and only two randomised trials. In the absence of new evidence from suitably-designed randomised trials, a definitive treatment recommendation cannot be made.
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急性肾脏损伤的步枪标准与重症患者的医院死亡率有关：一项队列分析。
影响因子：
15.1
作者：
Hoste, Eric A. J.;Clermont, Gilles;Kersten, Alexander;Venkataraman, Ramesh;Angus, Derek C.;De Bacquer, Dirk;Kellum, John A.
通讯作者：
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DOI：
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发表时间：
2007-07-01
影响因子：
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作者：
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通讯作者：
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影响因子：
1.3
作者：
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影响因子：
19.6
作者：
KLEINKNECHT, D;JUNGERS, P;GANEVAL, D
通讯作者：
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影响因子：
3.7
作者：
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通讯作者：
Kellum, John A.