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  • 田智超,陶煜,胡小红,毛志国.慢性肾衰竭患者透析起始肾小球滤过率与预后关系的meta分析[J].第二军医大学学报,2016,37(7):834-840    [点击复制]
  • TIAN Zhi-chao,TAO Yu,HU Xiao-hong,MAO Zhi-guo.Relationship between glomerular filtration rate at the initiation of dialysis and prognosis of chronic kidney failure patients: a meta-analysis[J].Acad J Sec Mil Med Univ,2016,37(7):834-840   [点击复制]
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慢性肾衰竭患者透析起始肾小球滤过率与预后关系的meta分析
田智超1△,陶煜2△,胡小红1,毛志国1*
0
(1. 第二军医大学长征医院肾脏病研究所, 上海 200003;
2. 第二军医大学东方肝胆外科医院肾内科, 上海 200438
共同第一作者
*通信作者)
摘要:
目的 通过系统回顾与meta分析方法探讨慢性肾衰竭患者开始透析时的肾小球滤过率(GFR)水平与其预后的关系。方法 以“dialysis initiation” “prognosis/mortality/survival” “timing” “CKD/CRF/ESRD”为关键词,检索PubMed、Medline、EMBASE、Cochrane Central Registry of Controlled Clinical Trials数据库,根据纳入及排除标准选择纳入的文献并进行meta分析。结果 共纳入20篇文献,包含21项研究。总体结果为透析起始GFR每增加1 mL/(min·1.73 m2),患者的全因死亡风险即升高3.3%(HR=1.033,95% CI: 1.026~1.040,P < 0.001)。对纳入的2项随机对照试验、4项各组生存分析起点设置为相同水平的研究分别进行亚组分析,结果均为透析起始GFR与患者生存率无关(HR=1.001,95%CI: 0.983~1.020,P = 0.891;HR=1.014,95%CI: 0.990~1.040,P = 0.260);对以GFR=10或10.5 mL/(min·1.73 m2)为分界点将患者分为早期和晚期两组的3项研究进行亚组分析,结果显示两组生存率差异亦无统计学意义(HR=1.062, 95%CI: 0.691~1.633, P = 0.784)。结论 目前的证据显示,慢性肾衰竭患者透析起始GFR越高,死亡风险越高。但导致患者早期透析的因素较复杂,仍需更多高质量的临床证据来决定合理的透析起始时机。
关键词:  肾透析  肾小球滤过率  慢性肾衰竭  预后  meta分析
DOI:10.16781/j.0258-879x.2016.07.0834
投稿时间:2016-01-03修订日期:2016-05-06
基金项目:
Relationship between glomerular filtration rate at the initiation of dialysis and prognosis of chronic kidney failure patients: a meta-analysis
TIAN Zhi-chao1△,TAO Yu2△,HU Xiao-hong1,MAO Zhi-guo1*
(1. Institute of Kidney Disease, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China;
2. Department of Nephrology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
* Corresponding author)
Abstract:
Objective To investigate the relationship between glomerular filtration rate (GFR) at the initiation of dialysis and the prognosis of chronic renal failure (CRF) patients via systematic review and meta analysis. Methods Literature retrieval was conducted using "dialysis initiation", "prognosis/mortality/survival", "timing", and "CKD/CRF/ESRD" as key words in databases including PubMed, Medline, EMBASE and Cochrane Central Registry of Controlled Clinical Trials. Literatures were selected according to the predefined inclusion and exclusion criteria and the data were analyzed using meta analysis. Results Finally 20 references containing 21 studies were included in the present study. The overall analysis showed that a 1 mL/(min·1.73 m2) GFR increment was associated with a 3.3% increase in all-cause mortality (HR=1.033, 95% CI:1.026-1.040, P < 0.001). However, the subgroup analysis of two RCTs and four studies with the same survival analysis origin demonstrated no significant correlation between GFR at dialysis initiation and survival rate (HR=1.001, 95%CI:0.983-1.020, P = 0.891; HR=1.014, 95%CI:0.990-1.040, P = 0.260). In addition, subgroup analysis including studies with 10 or 10.5 mL/(min·1.73 m2) GFR as the cut-off values between early and late stages also showed no significant differences in the survival rates (HR=1.062, 95%CI:0.691-1.633, P = 0.784). Conclusion It is indicated that higher GFR at dialysis initiation is associated with increased mortality rate of CRF patients; however, the reason for early dialysis is complicated and more high quality clinical trials are needed to determine the dialysis timing.
Key words:  renal dialysis  glomerular filtration rate  chronic renal failure  prognosis  meta-analysis