PDF(Pubmed)
Abstract：
UNASSIGNED: Patients with kidney failure treated with maintenance haemodialysis (HD) require appropriate small molecule clearance. Historically, a component of measuring \'dialysis adequacy\' has been quantified using urea kinetic modelling that is dependent on the HD prescription. However, the impact of dialysate flow rate on urea clearance remains poorly described in vivo and its influence on other patient-important outcomes of adequacy is uncertain.
UNASSIGNED: We searched Embase, MEDLINE and the Cochrane Library from inception until April 2022 for randomized controlled trials and observational trials comparing a higher dialysate flow rate (800 ml/min) and lower dialysate flow rate (300 ml/min) with a standard dialysis flow rate (500 ml/min) in adults (age ≥18 years) treated with maintenance HD (>90 consecutive days). We conducted a random effects meta-analysis to estimate the pooled mean difference in dialysis adequacy as measured by Kt/V or urea reduction ratio (URR).
UNASSIGNED: A total of 3118 studies were identified. Of those, nine met eligibility criteria and four were included in the meta-analysis. A higher dialysate flow rate (800 ml/min) increased single-pool Kt/V by 0.08 [95% confidence interval (CI) 0.05-0.10, P < .00001] and URR by 3.38 (95% CI 1.97-4.78, P < .00001) compared with a dialysate flow rate of 500 ml/min. Clinically relevant outcomes including symptoms, cognition, physical function and mortality were lacking and studies were generally at a moderate risk of bias due to issues with randomization sequence generation, allocation concealment and blinding.
UNASSIGNED: A higher dialysate flow increased urea-based markers of dialysis adequacy. Additional high-quality research is needed to determine the clinical, economic and environmental impacts of higher dialysate flow rates.
UNASSIGNED: We searched Embase, MEDLINE and the Cochrane Library from inception until April 2022 for randomized controlled trials and observational trials comparing a higher dialysate flow rate (800 ml/min) and lower dialysate flow rate (300 ml/min) with a standard dialysis flow rate (500 ml/min) in adults (age ≥18 years) treated with maintenance HD (>90 consecutive days). We conducted a random effects meta-analysis to estimate the pooled mean difference in dialysis adequacy as measured by Kt/V or urea reduction ratio (URR).
UNASSIGNED: A total of 3118 studies were identified. Of those, nine met eligibility criteria and four were included in the meta-analysis. A higher dialysate flow rate (800 ml/min) increased single-pool Kt/V by 0.08 [95% confidence interval (CI) 0.05-0.10, P < .00001] and URR by 3.38 (95% CI 1.97-4.78, P < .00001) compared with a dialysate flow rate of 500 ml/min. Clinically relevant outcomes including symptoms, cognition, physical function and mortality were lacking and studies were generally at a moderate risk of bias due to issues with randomization sequence generation, allocation concealment and blinding.
UNASSIGNED: A higher dialysate flow increased urea-based markers of dialysis adequacy. Additional high-quality research is needed to determine the clinical, economic and environmental impacts of higher dialysate flow rates.
摘要：
■接受维持性血液透析（HD）治疗的肾衰竭患者需要适当的小分子清除。历史上,使用依赖于HD处方的尿素动力学模型对测量“透析充分性”的一个组成部分进行了量化。然而,透析液流速对尿素清除率的影响在体内仍未得到充分描述,其对其他患者重要的充分性结局的影响尚不确定.
■我们搜索了Embase,MEDLINE和Cochrane图书馆从开始到2022年4月，用于随机对照试验和观察性试验，比较较高的透析液流速（800ml/min）和较低的透析液流速（300ml/min）与标准透析流速（500ml/min）在接受维持HD治疗（>连续90天）的成年人（年龄≥18岁）中。我们进行了随机效应荟萃分析，以估计通过Kt/V或尿素降低率（URR）测量的透析充分性的合并平均差。
■共确定了3118项研究。其中,9人符合入选标准,4人纳入荟萃分析.与500ml/min的透析液流速相比，较高的透析液流速（800ml/min）使单池Kt/V增加0.08[95％置信区间（CI）0.05-0.10，P<.00001]和URR增加3.38（95％CI1.97-4.78，P<.00001）。临床相关结果，包括症状，认知，缺乏身体功能和死亡率，由于随机序列生成的问题，研究通常处于中等偏倚风险，分配隐藏和致盲。
■较高的透析液流量增加了基于尿素的透析充分性标志物。需要额外的高质量研究来确定临床，较高的透析液流速对经济和环境的影响。
■我们搜索了Embase,MEDLINE和Cochrane图书馆从开始到2022年4月，用于随机对照试验和观察性试验，比较较高的透析液流速（800ml/min）和较低的透析液流速（300ml/min）与标准透析流速（500ml/min）在接受维持HD治疗（>连续90天）的成年人（年龄≥18岁）中。我们进行了随机效应荟萃分析，以估计通过Kt/V或尿素降低率（URR）测量的透析充分性的合并平均差。
■共确定了3118项研究。其中,9人符合入选标准,4人纳入荟萃分析.与500ml/min的透析液流速相比，较高的透析液流速（800ml/min）使单池Kt/V增加0.08[95％置信区间（CI）0.05-0.10，P<.00001]和URR增加3.38（95％CI1.97-4.78，P<.00001）。临床相关结果，包括症状，认知，缺乏身体功能和死亡率，由于随机序列生成的问题，研究通常处于中等偏倚风险，分配隐藏和致盲。
■较高的透析液流量增加了基于尿素的透析充分性标志物。需要额外的高质量研究来确定临床，较高的透析液流速对经济和环境的影响。
