■本研究的目的是确定维持性血液透析患者的虚弱与不良结局之间的关联强度。
■系统评价和荟萃分析。
■年龄≥18岁接受维持性血液透析的患者。
■PubMed,WebofScience,Embase,Cochrane图书馆,Scopus,中国知识资源综合数据库,从开始到2024年4月11日,都搜索了万方数据库和维普数据库。审稿人独立选择研究,提取数据并评估研究质量。使用Stata15.1软件进行荟萃分析。
■本研究共纳入36篇文章,包括56,867名患者。本研究的主要结局事件是死亡率,住院治疗,和血管通路事件。次要结果是抑郁,认知障碍,falls,骨折,睡眠障碍,和生活质量。这项研究表明,虚弱与维持性血液透析患者的死亡率相关[风险比(HR),1.97;95%CI,1.62-2.40]。虚弱增加了患者死亡的风险[比值比(OR),2.33;95%CI,1.47-3.68]。此外,我们发现,在接受维持性血液透析的患者中,虚弱与住院显著相关(OR,2.47;95%CI,1.52-4.03)。正在接受维持性血液透析且身体虚弱的患者住院风险更大[RR,1.47;95%CI,1.05-2.08]和紧急就诊(RR,2.28;95%CI,1.78-2.92)。这项研究的结果还表明,虚弱与血管通路事件的更大风险相关(HR,1.72;95%CI,1.50-1.97)。最后,虚弱会增加患抑郁症的风险(或,4.31;95%CI,1.83-10.18),跌倒和骨折,降低了生活质量。
■这项研究的结果表明,虚弱是维持性血液透析患者不良结局的重要预测因素。在未来,医务人员应定期评估虚弱的迹象,制定个体化诊疗方案,根据患者病情调整透析计划,减少不良事件的发生。
■研究协议已在PROSPERO上注册(https://www.crd.约克。AC.英国/PROSPERO/,编号:CRD42023486239)。
UNASSIGNED: The aim of this study was to determine the strength of the association between frailty and adverse outcomes in patients undergoing maintenance hemodialysis.
UNASSIGNED: A systematic review and meta-analysis.
UNASSIGNED: Patients aged ≥18 years who were undergoing maintenance hemodialysis.
UNASSIGNED: PubMed, Web of Science, Embase, the Cochrane Library, Scopus, the China Knowledge Resource Integrated Database, the Wanfang Database and the Weipu Database were searched from inception until 11 April 2024. The reviewers independently selected the studies, extracted the data and evaluated the quality of the studies. Stata 15.1 software was used to perform the meta-analysis.
UNASSIGNED: A total of 36 articles were included in this study, including 56,867 patients. The primary outcome events in this study were mortality, hospitalization, and vascular access events. The secondary outcomes were depression, cognitive impairment, falls, fracture, sleep disturbances, and quality of life. This study suggested that frailty was associated with mortality in patients undergoing maintenance hemodialysis [hazard ratio (HR), 1.97; 95% CI, 1.62-2.40]. Frailty increased the risk of mortality in patients [odds ratio (OR), 2.33; 95% CI, 1.47-3.68]. In addition, we found that frailty was significantly associated with hospitalization in patients undergoing maintenance hemodialysis (OR, 2.47; 95% CI, 1.52-4.03). Patients who were undergoing maintenance hemodialysis and who were frail had a greater risk of hospitalization [RR, 1.47; 95% CI, 1.05-2.08] and emergency visits (RR, 2.28; 95% CI, 1.78-2.92). The results of this study also suggested that frailty was associated with a greater risk of vascular access events (HR, 1.72; 95% CI, 1.50-1.97). Finally, frailty increased the risk of depression (OR, 4.31; 95% CI, 1.83-10.18), falls and fractures, and reduced quality of life.
UNASSIGNED: The findings of this study suggested that frailty was an important predictor of adverse outcomes in patients undergoing maintenance hemodialysis. In the future, medical staff should regularly evaluate signs of weakness, formulate individual diagnosis and treatment plans, adjust dialysis plans according to the patient\'s condition, and reduce the occurrence of adverse events.
UNASSIGNED: The study protocol was registered on PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, number: CRD42023486239).