医学
血液透析
透析
随机对照试验
肾脏疾病
内科学
肾脏替代疗法
血液滤过
荟萃分析
相对风险
重症监护医学
置信区间
作者
Amanda Y. Wang,Toshiharu Ninomiya,A. Al-Kahwa,Vlado Perkovic,Martin Gallagher,Carmel M. Hawley,Meg Jardine
标识
DOI:10.1053/j.ajkd.2014.01.435
摘要
Background
Whether convective modalities of dialysis, including hemofiltration (HF) and hemodiafiltration (HDF), improve cardiovascular outcomes and mortality is unclear. Study Design
Systematic review and meta-analysis. Setting & Population
Patients receiving HDF, HF, or standard hemodialysis (HD). Selection Criteria for Studies
Randomized controlled trials. Intervention
Convective modalities of dialysis (HDF and HF) versus standard HD. Outcomes
The primary outcome was clinical cardiovascular outcomes. Secondary outcomes were all-cause mortality, episodes of symptomatic hypotension, dialysis adequacy, and β2-microglobulin level. Relative risks (RRs) or weighted mean differences with 95% CIs for individual trials were pooled using random-effects models. Results
The search yielded 16 trials including 3,220 patients. Therapies assessed were convective modalities (HDF or HF) compared with standard HD. Compared with HD, convective modalities did not significantly reduce the risk of cardiovascular events (RR, 0.85; 95% CI, 0.66-1.10) or all-cause mortality (RR, 0.83; 95% CI, 0.65-1.05). Convective modalities reduced symptomatic hypotension (RR, 0.49; 95% CI, 0.30-0.81) and improved serum β2-microglobulin levels (−5.95mg/L; 95% CI, −10.27 to −1.64), but had no impact on small-molecule clearance (weighted mean difference in Kt/V, 0.04; 95% CI, −0.04 to 0.12). There was a nonsignificant trend to a greater likelihood of receiving a kidney transplant for participants allocated to filtration therapies (RR, 1.19; 95% CI, 0.99-1.42). Limitations
The trials were predominantly of suboptimal quality and underpowered, with imbalance in some prognostic variables at baseline. Intention-to-treat analysis was not used in some trials. Our analysis was limited to published outcomes. Conclusions
The potential benefits of convective modalities over standard HD for cardiovascular outcomes and mortality remain unproved. Further high-quality randomized trials are needed to define the impact of these modalities on clinically important outcomes.
科研通智能强力驱动
Strongly Powered by AbleSci AI