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.
■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。