دیالیز پریتونئال برای درمان نارسایی حاد کلیه
Referencias
منابع مطالعات واردشده در این مرور
منابع مطالعات خارجشده از این مرور
منابع اضافی
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Characteristics of studies
Characteristics of included studies [ordered by study ID]
Ir a:
| Methods |
| |
| Participants |
| |
| Interventions | Treatment group
Control group
| |
| Outcomes |
| |
| Notes |
| |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Study was described as randomised, method of randomisation was not reported |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement |
| Blinding of participants and personnel (performance bias) | High risk | Open‐label study |
| Blinding of outcome assessment (detection bias) | Unclear risk | Insufficient information to permit judgement |
| Incomplete outcome data (attrition bias) | Unclear risk | Insufficient information to permit judgement |
| Selective reporting (reporting bias) | High risk | Abstract‐only publication; data presented cannot be meta‐analysed |
| Other bias | Unclear risk | Insufficient information to permit judgement |
| Methods |
| |
| Participants |
| |
| Interventions | Treatment group
Control group
| |
| Outcomes |
| |
| Notes |
| |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomisation was performed using random‐number tables |
| Allocation concealment (selection bias) | Low risk | Consecutively numbered sealed envelopes |
| Blinding of participants and personnel (performance bias) | High risk | Open‐label study |
| Blinding of outcome assessment (detection bias) | Unclear risk | Insufficient information to permit judgement |
| Incomplete outcome data (attrition bias) | Low risk | No missing outcome data |
| Selective reporting (reporting bias) | Low risk | All expected outcomes were reported |
| Other bias | Low risk | The study appears to be free of other sources of bias |
| Methods |
| |
| Participants |
| |
| Interventions | Treatment group
Control group
| |
| Outcomes |
| |
| Notes |
| |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Study was described as randomised, method of randomisation was not reported |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement |
| Blinding of participants and personnel (performance bias) | High risk | Open‐label study |
| Blinding of outcome assessment (detection bias) | Unclear risk | Insufficient information to permit judgement |
| Incomplete outcome data (attrition bias) | Low risk | No missing outcome data |
| Selective reporting (reporting bias) | Low risk | All expected outcomes were reported |
| Other bias | Unclear risk | Part funded by Baxter Asia |
| Methods |
| |
| Participants |
| |
| Interventions | Treatment group
Control group
| |
| Outcomes |
| |
| Notes |
| |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Random‐number tables |
| Allocation concealment (selection bias) | Low risk | Consecutively numbered, sealed, opaque, double‐wrapped envelopes |
| Blinding of participants and personnel (performance bias) | High risk | Open‐label study |
| Blinding of outcome assessment (detection bias) | Unclear risk | Insufficient information to permit judgement |
| Incomplete outcome data (attrition bias) | Low risk | No missing outcome data |
| Selective reporting (reporting bias) | Unclear risk | Insufficient information to permit judgement as study was stopped early |
| Other bias | High risk | The study was stopped due to the difference in mortality rates |
| Methods |
| |
| Participants |
| |
| Interventions | Treatment group
Control group
| |
| Outcomes |
| |
| Notes |
| |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Study was described as randomised, method of randomisation was not reported |
| Allocation concealment (selection bias) | Low risk | Sealed envelopes |
| Blinding of participants and personnel (performance bias) | High risk | Open‐label study |
| Blinding of outcome assessment (detection bias) | Unclear risk | Insufficient information to permit judgement |
| Incomplete outcome data (attrition bias) | Unclear risk | 4 patients lost to follow‐up; all analyses were performed according to the intention‐to‐treat principle, with no imputation for missing values. Data from patients lost to follow‐up were not analysed |
| Selective reporting (reporting bias) | Unclear risk | All expected outcomes reported |
| Other bias | Unclear risk | Study appears to be free of other biases |
| Methods |
| |
| Participants |
| |
| Interventions | Treatment group
Control group
| |
| Outcomes |
| |
| Notes |
| |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Intervention assignment was generated by a computerised random number generated with separate lists at each centre |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement |
| Blinding of participants and personnel (performance bias) | High risk | Open‐label study |
| Blinding of outcome assessment (detection bias) | Unclear risk | Insufficient information to permit judgement |
| Incomplete outcome data (attrition bias) | Low risk | No missing outcome data |
| Selective reporting (reporting bias) | Low risk | All expected outcomes were reported |
| Other bias | High risk | There were significant differences between PD and extracorporeal therapy in some baseline characteristics, including pre‐dialysis BUN, and creatinine levels |
AKI ‐ acute kidney injury; APACHE ‐ Acute Physiology and Chronic Health Evaluation; AKNC ‐ Acute Kidney Network Criteria; ATN ‐ acute tubular necrosis; BUN ‐ blood urea nitrogen; CKD ‐ chronic kidney disease; CPD ‐ continuous peritoneal dialysis; CVVHDF ‐ continuous venovenous haemodiafiltration; EHD ‐ extended daily haemodialysis; HF ‐ haemofiltration; DHD ‐ daily haemodialysis; HVPD ‐ high volume peritoneal dialysis; ICU ‐ intensive care unit; M/F ‐ male/female; PD ‐ peritoneal dialysis; RCT ‐ randomised controlled trial; RRT ‐ renal replacement therapy; SCr ‐ serum creatinine; SD ‐ standard deviation; TPD ‐ tidal peritoneal dialysis
Characteristics of excluded studies [ordered by study ID]
Ir a:
| Study | Reason for exclusion |
| Wrong population: mix of AKI and CKD patients | |
| Cross‐over RCT; not appropriate study design for this review | |
| Wrong population: mix of AKI and CKD patients | |
| Wrong population: mix of AKI and CKD patients | |
| Wrong intervention: PD + verapamil versus HD; verapamil not used in the HD group |
AKi ‐ acute kidney injury; CKD ‐ chronic kidney disease; HD ‐ haemodialysis; PD ‐ peritoneal dialysis; RCT ‐ randomised controlled trial
Data and analyses
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 All‐cause mortality Show forest plot | 4 | 383 | Risk Ratio (M‐H, Random, 95% CI) | 1.12 [0.81, 1.55] |
| Analysis 1.1  Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 1 All‐cause mortality. | ||||
| 2 Recovery of kidney function Show forest plot | 3 | 333 | Risk Ratio (M‐H, Random, 95% CI) | 0.95 [0.68, 1.35] |
| Analysis 1.2  Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 2 Recovery of kidney function. | ||||
| 3 Weekly delivered Kt/V Show forest plot | 2 | 263 | Mean Difference (IV, Random, 95% CI) | ‐2.47 [‐5.17, 0.22] |
| Analysis 1.3  Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 3 Weekly delivered Kt/V. | ||||
| 4 Correction of acidosis Show forest plot | 2 | 89 | Risk Ratio (M‐H, Random, 95% CI) | 1.32 [0.13, 13.60] |
| Analysis 1.4  Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 4 Correction of acidosis. | ||||
| 5 Fluid removal Show forest plot | 3 | 313 | Mean Difference (IV, Random, 95% CI) | ‐0.59 [‐1.19, 0.01] |
| Analysis 1.5  Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 5 Fluid removal. | ||||
| 6 Duration of dialysis Show forest plot | 2 | 170 | Mean Difference (IV, Random, 95% CI) | ‐1.01 [‐91.49, 89.47] |
| Analysis 1.6  Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 6 Duration of dialysis. | ||||
| 7 Infectious complications (catheter infection or peritonitis) Show forest plot | 2 | 263 | Risk Ratio (M‐H, Random, 95% CI) | 1.03 [0.60, 1.78] |
| Analysis 1.7  Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 7 Infectious complications (catheter infection or peritonitis). | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 All‐cause mortality Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| Analysis 2.1  Comparison 2 High versus low intensity peritoneal dialysis, Outcome 1 All‐cause mortality. | ||||
| 2 Recovery of kidney function Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| Analysis 2.2  Comparison 2 High versus low intensity peritoneal dialysis, Outcome 2 Recovery of kidney function. | ||||
| 3 Weekly delivered Kt/V Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 2.3  Comparison 2 High versus low intensity peritoneal dialysis, Outcome 3 Weekly delivered Kt/V. | ||||
| 4 Fluid removal Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 2.4  Comparison 2 High versus low intensity peritoneal dialysis, Outcome 4 Fluid removal. | ||||
| 5 Infectious complications (catheter infection or peritonitis) Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| Analysis 2.5  Comparison 2 High versus low intensity peritoneal dialysis, Outcome 5 Infectious complications (catheter infection or peritonitis). | ||||
Flow chart of the article selection process
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 1 All‐cause mortality.
Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 2 Recovery of kidney function.
Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 3 Weekly delivered Kt/V.
Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 4 Correction of acidosis.
Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 5 Fluid removal.
Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 6 Duration of dialysis.
Comparison 1 Peritoneal dialysis versus extracorporeal therapy, Outcome 7 Infectious complications (catheter infection or peritonitis).
Comparison 2 High versus low intensity peritoneal dialysis, Outcome 1 All‐cause mortality.
Comparison 2 High versus low intensity peritoneal dialysis, Outcome 2 Recovery of kidney function.
Comparison 2 High versus low intensity peritoneal dialysis, Outcome 3 Weekly delivered Kt/V.
Comparison 2 High versus low intensity peritoneal dialysis, Outcome 4 Fluid removal.
Comparison 2 High versus low intensity peritoneal dialysis, Outcome 5 Infectious complications (catheter infection or peritonitis).
| Peritoneal dialysis versus extracorporeal therapy for acute kidney injury | ||||||
| Patient or population: patients with acute kidney injury Settings: inpatient Intervention: peritoneal dialysis Comparison: extracorporeal therapy | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No. of participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Extracorporeal therapy | Peritoneal dialysis | |||||
| All‐cause mortality | 542 per 1000 | 607 per 1000 (439 to 841) | RR 1.12 (0.81 to 1.55) | 4 (383) | ⊕⊕⊕⊝ | Downgraded for study limitations |
| Recovery of kidney function | 284 per 1000 | 270 per 1000 (193 to 384) | RR 1.42 (0.74 to 2.75) | 3 (333) | ⊕⊕⊕⊝ | Downgraded for study limitations |
| Weekly delivered Kt/V | The mean delivered Kt/V was 2.47 lower (5.17 lower to 0.22 higher) in the peritoneal dialysis group compared to the extracorporeal therapy group | 2 (263) | ⊕⊝⊝⊝ | Downgraded for study limitations, imprecision and insufficient data | ||
| Correction of acidosis | 577 per 1000 | 762 per 1000 (70 to 1,000) | RR 1.32 (0.1 to 13.60) | 2 (120) | ⊕⊝⊝⊝ | Downgraded for study limitations, imprecision and insufficient data |
| Fluid removal (L/d) | The mean fluid removal was 0.59 L/d lower (1.19 lower to 0.01 higher) in the peritoneal dialysis group compared to the extracorporeal therapy group | 3 (313) | ⊕⊕⊝⊝ | Downgraded for study limitations and imprecision | ||
| Duration of dialysis (hours) | The mean duration of dialysis was 1.01 hours less (91.49 lower to 92.54 higher) in the peritoneal dialysis group compared to the extracorporeal therapy group | 2 (170) | ⊕⊝⊝⊝ | Downgraded for study limitations, imprecision and insufficient data | ||
| Infectious complications | 169 per 1000 | 174 per 1000 (101 to 301) | RR 1.03 (0.60 to 1.78) | 2 (263) | ⊕⊕⊝⊝ | Downgraded for study limitations and insufficient data |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Three studies did not report details about random sequence generation or allocation concealment or both 2Small numbers with wide CI 3Few studies (no more than 2) reported the relevant data | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 All‐cause mortality Show forest plot | 4 | 383 | Risk Ratio (M‐H, Random, 95% CI) | 1.12 [0.81, 1.55] |
| 2 Recovery of kidney function Show forest plot | 3 | 333 | Risk Ratio (M‐H, Random, 95% CI) | 0.95 [0.68, 1.35] |
| 3 Weekly delivered Kt/V Show forest plot | 2 | 263 | Mean Difference (IV, Random, 95% CI) | ‐2.47 [‐5.17, 0.22] |
| 4 Correction of acidosis Show forest plot | 2 | 89 | Risk Ratio (M‐H, Random, 95% CI) | 1.32 [0.13, 13.60] |
| 5 Fluid removal Show forest plot | 3 | 313 | Mean Difference (IV, Random, 95% CI) | ‐0.59 [‐1.19, 0.01] |
| 6 Duration of dialysis Show forest plot | 2 | 170 | Mean Difference (IV, Random, 95% CI) | ‐1.01 [‐91.49, 89.47] |
| 7 Infectious complications (catheter infection or peritonitis) Show forest plot | 2 | 263 | Risk Ratio (M‐H, Random, 95% CI) | 1.03 [0.60, 1.78] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 All‐cause mortality Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| 2 Recovery of kidney function Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| 3 Weekly delivered Kt/V Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 4 Fluid removal Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 5 Infectious complications (catheter infection or peritonitis) Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Totals not selected | |
