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.
■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。