PDF(Pubmed)
Abstract：
UNASSIGNED: Appropriate dialysis prescription in the transitional setting from chronic kidney disease to end-stage kidney disease is still challenging. Conventional thrice-weekly haemodialysis (HD) might be associated with rapid loss of residual kidney function (RKF) and high mortality. The benefits and risks of incremental HD compared with conventional HD were explored in this systematic review and meta-analysis.
UNASSIGNED: We searched MEDLINE, Scopus and Cochrane Central Register of Controlled Trials up to April 2023 for studies that compared the impacts of incremental (once- or twice-weekly HD) and conventional thrice-weekly HD on cardiovascular events, RKF, vascular access complications, quality of life, hospitalization and mortality.
UNASSIGNED: A total of 36 articles (138 939 participants) were included in this meta-analysis. The mortality rate and cardiovascular events were similar between incremental and conventional HD {odds ratio [OR] 0.87 [95% confidence interval (CI)] 0.72-1.04 and OR 0.67 [95% CI 0.43-1.05], respectively}. However, hospitalization and loss of RKF were significantly lower in patients treated with incremental HD [OR 0.44 (95% CI 0.27-0.72) and OR 0.31 (95% CI 0.25-0.39), respectively]. In a sensitivity analysis that included studies restricted to those with RKF or urine output criteria, incremental HD had significantly lower cardiovascular events [OR 0.22 (95% CI 0.08-0.63)] and mortality [OR 0.54 (95% CI 0.37-0.79)]. Vascular access complications, hyperkalaemia and volume overload were not statistically different between groups.
UNASSIGNED: Incremental HD has been shown to be safe and may provide superior benefits in clinical outcomes, particularly in appropriately selected patients. Large-scale randomized controlled trials are required to confirm these potential advantages.
UNASSIGNED: We searched MEDLINE, Scopus and Cochrane Central Register of Controlled Trials up to April 2023 for studies that compared the impacts of incremental (once- or twice-weekly HD) and conventional thrice-weekly HD on cardiovascular events, RKF, vascular access complications, quality of life, hospitalization and mortality.
UNASSIGNED: A total of 36 articles (138 939 participants) were included in this meta-analysis. The mortality rate and cardiovascular events were similar between incremental and conventional HD {odds ratio [OR] 0.87 [95% confidence interval (CI)] 0.72-1.04 and OR 0.67 [95% CI 0.43-1.05], respectively}. However, hospitalization and loss of RKF were significantly lower in patients treated with incremental HD [OR 0.44 (95% CI 0.27-0.72) and OR 0.31 (95% CI 0.25-0.39), respectively]. In a sensitivity analysis that included studies restricted to those with RKF or urine output criteria, incremental HD had significantly lower cardiovascular events [OR 0.22 (95% CI 0.08-0.63)] and mortality [OR 0.54 (95% CI 0.37-0.79)]. Vascular access complications, hyperkalaemia and volume overload were not statistically different between groups.
UNASSIGNED: Incremental HD has been shown to be safe and may provide superior benefits in clinical outcomes, particularly in appropriately selected patients. Large-scale randomized controlled trials are required to confirm these potential advantages.
摘要：
■在从慢性肾脏疾病到终末期肾脏疾病的过渡背景下，适当的透析处方仍然具有挑战性。常规每周三次血液透析（HD）可能与残余肾功能（RKF）的快速丧失和高死亡率有关。本系统综述和荟萃分析探讨了增量HD与传统HD相比的益处和风险。
■我们搜索了MEDLINE,截至2023年4月，Scopus和Cochrane中央对照试验登记册，用于比较增量（每周一次或两次HD）和常规每周三次HD对心血管事件的影响，RKF,血管通路并发症,生活质量,住院和死亡率。
■本荟萃分析共纳入36篇文章（138.939名参与者）。增量HD和常规HD的死亡率和心血管事件相似{比值比[OR]0.87[95%置信区间(CI)]0.72-1.04和OR0.67[95%CI0.43-1.05],分别}。然而,在接受增量HD治疗的患者中，住院率和RKF损失显著降低[OR0.44(95%CI0.27-0.72)和OR0.31(95%CI0.25-0.39)，分别]。在敏感性分析中，包括限制于RKF或尿量标准的研究，增量HD的心血管事件[OR0.22(95%CI0.08-0.63)]和死亡率[OR0.54(95%CI0.37-0.79)]显著降低.血管通路并发症,高钾血症和容量超负荷在组间无统计学差异.
■增量HD已被证明是安全的，并且可能在临床结果中提供卓越的益处，特别是在适当选择的患者中。需要大规模的随机对照试验来证实这些潜在的优势。
■我们搜索了MEDLINE,截至2023年4月，Scopus和Cochrane中央对照试验登记册，用于比较增量（每周一次或两次HD）和常规每周三次HD对心血管事件的影响，RKF,血管通路并发症,生活质量,住院和死亡率。
■本荟萃分析共纳入36篇文章（138.939名参与者）。增量HD和常规HD的死亡率和心血管事件相似{比值比[OR]0.87[95%置信区间(CI)]0.72-1.04和OR0.67[95%CI0.43-1.05],分别}。然而,在接受增量HD治疗的患者中，住院率和RKF损失显著降低[OR0.44(95%CI0.27-0.72)和OR0.31(95%CI0.25-0.39)，分别]。在敏感性分析中，包括限制于RKF或尿量标准的研究，增量HD的心血管事件[OR0.22(95%CI0.08-0.63)]和死亡率[OR0.54(95%CI0.37-0.79)]显著降低.血管通路并发症,高钾血症和容量超负荷在组间无统计学差异.
■增量HD已被证明是安全的，并且可能在临床结果中提供卓越的益处，特别是在适当选择的患者中。需要大规模的随机对照试验来证实这些潜在的优势。
