Reducing Mortality in Acute Kidney Injury Patients: Systematic Review and International Web-Based Survey
Reducing Mortality in Acute Kidney Injury Patients: Systematic Review and International Web-Based Survey
复制标题
DOI：
10.1053/j.jvca.2013.06.028
复制
发表时间：
2013-12-01
影响因子：
2.8
通讯作者：
Bellomo, Rinaldo
中科院分区：
文献类型：
--
作者：
Landoni, Giovanni;Bove, Tiziana;Bellomo, Rinaldo
目的：确定所有增加或减少急性肾损伤（阿基）患者死亡率的干预措施，并在这种情况下建立声明信念和实际实践之间的一致性。设计和设置：系统性文献综述和国际网络调查。参与者：来自62个国家的300多名医生。干预措施：检索了几个数据库，包括MEDLINE/PubMed，没有时间限制（2012年2月14日更新），以确定符合以下所有标准的所有药物/技术/策略：（a）发表在同行评议的期刊上，（B）涉及患有急性肾损伤或有急性肾损伤风险的危重成人患者，（c）报告死亡率在统计学上显著降低或增加。围手术期血流动力学优化、白蛋白治疗尿毒症患者、特利加压素治疗1型肝肾综合征、人免疫球蛋白、血管造影术周围血液滤过、非诺多泮、多发性骨髓瘤相关阿基的血浆置换、肾脏替代治疗（RAT）强度增加、严重烧伤患者的CVVH、加压素治疗脓毒性休克、呋塞米持续输注、柠檬酸盐治疗连续RRT、N-乙酰半胱氨酸、持续和早期ART可能降低有AKI或有阿基风险的重症患者的死亡率;正液体平衡、羟乙基淀粉和袢利尿剂可能增加有AKI或有AKI风险的重症患者的死亡率。基于网络的意见与30%的干预措施的共识意见和3种干预措施的自我报告实践不同。作者确定了至少1项研究表明对AKI患者或有阿基风险的患者的死亡率有显著影响的所有干预措施，并发现参与者陈述的信念与这些主题的实际实践之间存在不一致。(C)2013 Elsevier Inc. All rights reserved.
Objective: To identify all interventions that increase or reduce mortality in patients with acute kidney injury (AKI) and to establish the agreement between stated beliefs and actual practice in this setting.Design and Setting: Systematic literature review and international web-based survey.Participants: More than 300 physicians from 62 countries.Interventions: Several databases, including MEDLINE/PubMed, were searched with no time limits (updated February 14, 2012) to identify all the drugs/techniques/ strategies that fulfilled all the following criteria: (a) published in a peer-reviewed journal, (b) dealing with critically ill adult patients with or at risk for acute kidney injury, and (c) reporting a statistically significant reduction or increase in mortality.Measurements and Main Results: Of the 18 identified interventions, 15 reduced mortality and 3 increased mortality. Perioperative hemodynamic optimization, albumin in cirrhotic patients, terlipressin for hepatorenal syndrome type 1, human immunoglobulin, peri-angiography hemofiltration, fenoldopam, plasma exchange in multiple-myeloma-associated AKI, increased intensity of renal replacement therapy (RAT), CVVH in severely burned patients, vasopressin in septic shock, furosemide by continuous infusion, citrate in continuous RRT, N-acetylcysteine, continuous and early ART might reduce mortality in critically ill patients with or at risk for AKI; positive fluid balance, hydroxyethyl starch and loop diuretics might increase mortality in critically ill patients with or at risk for An Web-based opinion differed from consensus opinion for 30% of interventions and self-reported practice for 3 interventions.Conclusion: The authors identified all interventions with at least 1 study suggesting a significant effect on mortality in patients with or at risk of AKI and found that there is discordance between participant stated beliefs and actual practice regarding these topics. (C) 2013 Elsevier Inc. All rights reserved.