成年血液透析患者不同封管液应用效果的网状Meta分析
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摘要
目的评估不同封管液对成人血液透析患者的封管效果。方法通过计算机检索PubMed、Cochrane Library、Embase、中国知网、万方数据库、维普数据库,检索时间为建库至2018年9月。收集不同封管液对血液透析患者封管效果比较的随机对照试验。使用Cochrane 5.1.0系统评价手册进行质量评价,Stata12.0软件绘制网络图,WinBUGS进行数据分析。结果最终纳入文献15篇,包含7种封管液,共计样本量2 159例。网状Meta结果显示,对于导管相关性感染、导管接口处感染以及病死3个结局指标,各个研究结果比较,差异无统计学意义,但就概率排序,对降低导管相关性感染、导管接口处感染以及病死的发生,最优的封管液分别为抗生素、枸橼酸盐和乙醇。结论结合网状Meta分析结果和概率排序,考虑抗生素耐药特性,推荐乙醇或枸橼酸盐作为血液透析患者的封管液。
Objective To evaluate the effect of various locking solutions for hemodialysis catheters in adults patients.Methods PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure(CNKI), Wanfang Data, and VIP database were searched to collect randomized controlled trials(RCTs) on usage of different locking solutions to lock the hemodialysis catheters in adult patients, with the publication time being limited to database inception to September,2018. The Cochrane 5.1.0 systematic review manual was used for quality evaluation, the Stata 12.0 software was used to draw the network diagram, and the WinBUGS was used for data analysis.Results A total of 15 publications were included, reporting 8 kinds of locking solutions, with a total sample size of 2 159 cases. The results of network meta analysis showed no statistically significant differences in 3 outcome mea-sures(catheter-related infections, infection at the catheter interface, and death).However, from the probability ranking table, the optimal locking solutions were antibiotics, citrate and ethanol, which were beneficial to the reduction in catheter-related infections, infection at the catheter interface and the occurrence of death.Conclusion Through a combination of the results of network meta analysis and the probability ranking table, given that long-term use of antibiotics can lead to bacterial resistance, ethanol or citrate can be recommended as a sealing solution for hemodialysis patients.
Objective To evaluate the effect of various locking solutions for hemodialysis catheters in adults patients.Methods PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure(CNKI), Wanfang Data, and VIP database were searched to collect randomized controlled trials(RCTs) on usage of different locking solutions to lock the hemodialysis catheters in adult patients, with the publication time being limited to database inception to September,2018. The Cochrane 5.1.0 systematic review manual was used for quality evaluation, the Stata 12.0 software was used to draw the network diagram, and the WinBUGS was used for data analysis.Results A total of 15 publications were included, reporting 8 kinds of locking solutions, with a total sample size of 2 159 cases. The results of network meta analysis showed no statistically significant differences in 3 outcome mea-sures(catheter-related infections, infection at the catheter interface, and death).However, from the probability ranking table, the optimal locking solutions were antibiotics, citrate and ethanol, which were beneficial to the reduction in catheter-related infections, infection at the catheter interface and the occurrence of death.Conclusion Through a combination of the results of network meta analysis and the probability ranking table, given that long-term use of antibiotics can lead to bacterial resistance, ethanol or citrate can be recommended as a sealing solution for hemodialysis patients.
引文
[1] Jha V,Garcia-Garcia G,Iseki K,et al.Chronic kidney disease:global dimension and perspectives[J].Lancet,2013,382(9888):260-272.
[2] Saran R,Hedgeman E,Huseini M,et al.Surveillance of chronic kidney disease around the world:tracking and reining in a global problem[J].Adv Chronic Kidney Dis,2010,17(3):271-281.
[3] Yuan Q,Xiong Q C,Gupta M,et al.Dental implant treatment for renal failure patients on dialysis:a clinical guideline[J].Int J Oral Sci,2017,9(3):125-132.
[4] Lysaght M J.Maintenance dialysis population dynamics:current trends and long-term implications[J].J Am Soc Nephrol,2002,13(Suppl 1):37-40.
[5] 汪月娟.中国成人高血压患者空腹血糖状态与肾小球高滤过的关联性分析及高滤过对肾病进展风险影响的队列研究[D].广州:南方医科大学,2015.
[6] Zhang L,Wang F,Wang L,et al.Prevalence of chronic kidney disease in China:a cross-sectional survey[J].Lancet,2012,379(9818):815-822.
[7] Saran R,Li Y,Robinson B,et al.US renal data system 2014 annual data report:epidemiology of kidney disease in the United States[J].Am J Kidney Dis,2015,66(Suppl 1):Svii,S1-S305.
[8] Collins A J,Foley R N,Chavers B,et al.US renal data system 2013 annual data report[J].Am J Kidney Dis,2014,63(1Suppl):A7.
[9] MacNeill S J,Casula A,Shaw C,et al.UK renal registry 18th annual report:chapter 2 UK renal replacement therapy prevalence in 2014:national and centre-specific analyses[J].Nephron,2016,132(Suppl 1):41-68.
[10] Saran R,Robinson B,Abbott K C,et al.US renal data system 2017 annual data report:epidemiology of kidney disease in the United States[J].Am J Kidney Dis,2018,71(4):501.
[11] Ravani P,Quinn R,Oliver M,et al.Examining the association between hemodialysis access type and mortality:the role of access complications[J].Clin J Am Soc Nephrol,2017,12(6):955-964.
[12] Pschowski R,Briegel S,Von Haehling S,et al.Effects of dialysis modality on blood loss,bleeding complications and transfusion requirements in critically ill patients with dialysis-dependent acute renal failure[J].Anaesth Intensive Care,2015,43(6):764-770.
[13] Sofrondiadou S,Revela I,Kouloubinis A,et al.Ethanol combined with heparin as a locking solution for the prevention of catheter related blood stream infections in hemodialysis patients:a prospective randomized study[J].Hemodial Int,2017,21(4):498-506.
[14] Núňez-Moral M,Sánchez-álvarez E,González-Díaz I,et al.Exit-site infection of peritoneal catheter is reduced by the use of polyhexanide.Results of a prospective rando-mized trial[J].Perit Dial Int,2014,34(3):271-277.
[15] Amira C O,Bello B T,Braimoh R W.A study of outcome and complications associated with temporary hemodialysis catheters in a Nigerian dialysis unit[J].Saudi J Kidney Dis Transpl,2016,27(3):569-575.
[16] Higgins J P,Altman D G,Gotzsche P C,et al.The Cochrane Collaboration′s tool for assessing risk of bias in randomised trials[J].BMJ,2011,343:d5928.
[17] Winnicki W,Herkner H,Lorenz M,et al.Taurolidine-based catheter lock regimen significantly reduces overall costs,infection,and dysfunction rates of tunneled hemodialysis catheters[J].Kidney Int,2018,93(3):753-760.
[18] Vercaigne L M,Allan D R,Armstrong S W,et al.An ethanol/sodium citrate locking solution compared to he-parin to prevent hemodialysis catheter-related infections:a randomized pilot study[J].J Vasc Access,2016,17(1):55-62.
[19] Luiz M V,Scavone C,Tzanno C.The CLOCK trial,a double-blinded randomized controlled trial:trisodium citrate 30% and minocycline 3 mg/mL plus EDTA 30 mg/mL are effective and safe for catheter patency maintenance among CKD 5D patients on hemodialysis[J].Hemodial Int,2017,21(2):294-304.
[20] Correa Barcellos F,Pereira Nunes B,Jorge Valle L,et al.Comparative effectiveness of 30% trisodium citrate and heparin lock solution in preventing infection and dysfunction of hemodialysis catheters:a randomized controlled trial (CITRIM trial)[J].Infection,2017,45(2):139-145.
[21] Kanaa M,Wright M J,Akbani H,et al.Cathasept line lock and microbial colonization of tunneled hemodialysis catheters:a multicenter randomized controlled trial[J].Am J Kidney Dis,2015,66(6):1015-1023.
[22] Boersma R S,Jie K S,Voogd A C,et al.Concentrated citrate locking in order to reduce the long-term complications of central venous catheters:a randomized controlled trial in patients with hematological malignancies[J].Support Care Cancer,2015,23(1):37-45.
[23] Broom J K,Krishnasamy R,Hawley C M,et al.A randomised controlled trial of Heparin versus EthAnol Lock THerapY for the prevention of Catheter Associated infecTion in Haemodialysis patients-the HEALTHY-CATH trial[J].BMC Nephrol,2012,13:146.
[24] Hemmelgarn B R,Moist L M,Lok C E,et al.Prevention of dialysis catheter malfunction with recombinant tissue plasminogen activator[J].N Engl J Med,2011,364(4):303-312.
[25] Solomon L R,Cheesbrough J S,Ebah L,et al.A randomized double-blind controlled trial of taurolidine-citrate catheter locks for the prevention of bacteremia in patients treated with hemodialysis[J].Am J Kidney Dis,2010,55(6):1060-1068.
[26] Zhang P,Yuan J,Tan H,et al.Successful prevention of cuffed hemodialysis catheter-related infection using an antibiotic lock technique by strictly catheter-restricted antibiotic lock solution method[J].Blood Purif,2009,27(2):206-211.
[27] Saxena A K,Panhotra B R,Sundaram D S,et al.Enhancing the survival of tunneled haemodialysis catheters using an antibiotic lock in the elderly:a randomised,double-blind clinical trial[J].Nephrology (Carlton),2006,11(4):299-305.
[28] Nori U S,Manoharan A,Yee J,et al.Comparison of low-dose gentamicin with minocycline as catheter lock solutions in the prevention of catheter-related bacteremia[J].Am J Kidney Dis,2006,48(4):596-605.
[29] Weijmer M C,van den Dorpel M A,Van de Ven P J,et al.Randomized,clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients[J].J Am Soc Nephrol,2005,16(9):2769-2777.
[30] Dogra G K,Herson H,Hutchison B,et al.Prevention of tunneled hemodialysis catheter-related infections using catheter-restricted filling with gentamicin and citrate:a randomized controlled study[J].J Am Soc Nephrol,2002,13(8):2133-2139.
[31] Arechabala M C,Catoni M I,Claro J C,et al.Antimicrobial lock solutions for preventing catheter-related infections in haemodialysis[J].Cochrane Database Syst Rev,2018,4:Cd010597.
[32] Allon M.Prophylactic effect of antibiotic lock solution on bacteremia related to use of uncuffed hemodialysis catheters[J].Nat Clin Pract Nephrol,2006,2(8):418-419.
[33] 韩新,曹艳佩,杨晓莉,等.枸橼酸盐和肝素钠用于成人血液透析导管封管有效性的Meta分析[J].护理学杂志,2015,30(21):88-92.
[34] Shanks R M,Sargent J L,Martinez R M,et al.Catheter lock solutions influence staphylococcal biofilm formation on abiotic surfaces[J].Nephrol Dial Transplant,2006,21(8):2247-2255.
[2] Saran R,Hedgeman E,Huseini M,et al.Surveillance of chronic kidney disease around the world:tracking and reining in a global problem[J].Adv Chronic Kidney Dis,2010,17(3):271-281.
[3] Yuan Q,Xiong Q C,Gupta M,et al.Dental implant treatment for renal failure patients on dialysis:a clinical guideline[J].Int J Oral Sci,2017,9(3):125-132.
[4] Lysaght M J.Maintenance dialysis population dynamics:current trends and long-term implications[J].J Am Soc Nephrol,2002,13(Suppl 1):37-40.
[5] 汪月娟.中国成人高血压患者空腹血糖状态与肾小球高滤过的关联性分析及高滤过对肾病进展风险影响的队列研究[D].广州:南方医科大学,2015.
[6] Zhang L,Wang F,Wang L,et al.Prevalence of chronic kidney disease in China:a cross-sectional survey[J].Lancet,2012,379(9818):815-822.
[7] Saran R,Li Y,Robinson B,et al.US renal data system 2014 annual data report:epidemiology of kidney disease in the United States[J].Am J Kidney Dis,2015,66(Suppl 1):Svii,S1-S305.
[8] Collins A J,Foley R N,Chavers B,et al.US renal data system 2013 annual data report[J].Am J Kidney Dis,2014,63(1Suppl):A7.
[9] MacNeill S J,Casula A,Shaw C,et al.UK renal registry 18th annual report:chapter 2 UK renal replacement therapy prevalence in 2014:national and centre-specific analyses[J].Nephron,2016,132(Suppl 1):41-68.
[10] Saran R,Robinson B,Abbott K C,et al.US renal data system 2017 annual data report:epidemiology of kidney disease in the United States[J].Am J Kidney Dis,2018,71(4):501.
[11] Ravani P,Quinn R,Oliver M,et al.Examining the association between hemodialysis access type and mortality:the role of access complications[J].Clin J Am Soc Nephrol,2017,12(6):955-964.
[12] Pschowski R,Briegel S,Von Haehling S,et al.Effects of dialysis modality on blood loss,bleeding complications and transfusion requirements in critically ill patients with dialysis-dependent acute renal failure[J].Anaesth Intensive Care,2015,43(6):764-770.
[13] Sofrondiadou S,Revela I,Kouloubinis A,et al.Ethanol combined with heparin as a locking solution for the prevention of catheter related blood stream infections in hemodialysis patients:a prospective randomized study[J].Hemodial Int,2017,21(4):498-506.
[14] Núňez-Moral M,Sánchez-álvarez E,González-Díaz I,et al.Exit-site infection of peritoneal catheter is reduced by the use of polyhexanide.Results of a prospective rando-mized trial[J].Perit Dial Int,2014,34(3):271-277.
[15] Amira C O,Bello B T,Braimoh R W.A study of outcome and complications associated with temporary hemodialysis catheters in a Nigerian dialysis unit[J].Saudi J Kidney Dis Transpl,2016,27(3):569-575.
[16] Higgins J P,Altman D G,Gotzsche P C,et al.The Cochrane Collaboration′s tool for assessing risk of bias in randomised trials[J].BMJ,2011,343:d5928.
[17] Winnicki W,Herkner H,Lorenz M,et al.Taurolidine-based catheter lock regimen significantly reduces overall costs,infection,and dysfunction rates of tunneled hemodialysis catheters[J].Kidney Int,2018,93(3):753-760.
[18] Vercaigne L M,Allan D R,Armstrong S W,et al.An ethanol/sodium citrate locking solution compared to he-parin to prevent hemodialysis catheter-related infections:a randomized pilot study[J].J Vasc Access,2016,17(1):55-62.
[19] Luiz M V,Scavone C,Tzanno C.The CLOCK trial,a double-blinded randomized controlled trial:trisodium citrate 30% and minocycline 3 mg/mL plus EDTA 30 mg/mL are effective and safe for catheter patency maintenance among CKD 5D patients on hemodialysis[J].Hemodial Int,2017,21(2):294-304.
[20] Correa Barcellos F,Pereira Nunes B,Jorge Valle L,et al.Comparative effectiveness of 30% trisodium citrate and heparin lock solution in preventing infection and dysfunction of hemodialysis catheters:a randomized controlled trial (CITRIM trial)[J].Infection,2017,45(2):139-145.
[21] Kanaa M,Wright M J,Akbani H,et al.Cathasept line lock and microbial colonization of tunneled hemodialysis catheters:a multicenter randomized controlled trial[J].Am J Kidney Dis,2015,66(6):1015-1023.
[22] Boersma R S,Jie K S,Voogd A C,et al.Concentrated citrate locking in order to reduce the long-term complications of central venous catheters:a randomized controlled trial in patients with hematological malignancies[J].Support Care Cancer,2015,23(1):37-45.
[23] Broom J K,Krishnasamy R,Hawley C M,et al.A randomised controlled trial of Heparin versus EthAnol Lock THerapY for the prevention of Catheter Associated infecTion in Haemodialysis patients-the HEALTHY-CATH trial[J].BMC Nephrol,2012,13:146.
[24] Hemmelgarn B R,Moist L M,Lok C E,et al.Prevention of dialysis catheter malfunction with recombinant tissue plasminogen activator[J].N Engl J Med,2011,364(4):303-312.
[25] Solomon L R,Cheesbrough J S,Ebah L,et al.A randomized double-blind controlled trial of taurolidine-citrate catheter locks for the prevention of bacteremia in patients treated with hemodialysis[J].Am J Kidney Dis,2010,55(6):1060-1068.
[26] Zhang P,Yuan J,Tan H,et al.Successful prevention of cuffed hemodialysis catheter-related infection using an antibiotic lock technique by strictly catheter-restricted antibiotic lock solution method[J].Blood Purif,2009,27(2):206-211.
[27] Saxena A K,Panhotra B R,Sundaram D S,et al.Enhancing the survival of tunneled haemodialysis catheters using an antibiotic lock in the elderly:a randomised,double-blind clinical trial[J].Nephrology (Carlton),2006,11(4):299-305.
[28] Nori U S,Manoharan A,Yee J,et al.Comparison of low-dose gentamicin with minocycline as catheter lock solutions in the prevention of catheter-related bacteremia[J].Am J Kidney Dis,2006,48(4):596-605.
[29] Weijmer M C,van den Dorpel M A,Van de Ven P J,et al.Randomized,clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients[J].J Am Soc Nephrol,2005,16(9):2769-2777.
[30] Dogra G K,Herson H,Hutchison B,et al.Prevention of tunneled hemodialysis catheter-related infections using catheter-restricted filling with gentamicin and citrate:a randomized controlled study[J].J Am Soc Nephrol,2002,13(8):2133-2139.
[31] Arechabala M C,Catoni M I,Claro J C,et al.Antimicrobial lock solutions for preventing catheter-related infections in haemodialysis[J].Cochrane Database Syst Rev,2018,4:Cd010597.
[32] Allon M.Prophylactic effect of antibiotic lock solution on bacteremia related to use of uncuffed hemodialysis catheters[J].Nat Clin Pract Nephrol,2006,2(8):418-419.
[33] 韩新,曹艳佩,杨晓莉,等.枸橼酸盐和肝素钠用于成人血液透析导管封管有效性的Meta分析[J].护理学杂志,2015,30(21):88-92.
[34] Shanks R M,Sargent J L,Martinez R M,et al.Catheter lock solutions influence staphylococcal biofilm formation on abiotic surfaces[J].Nephrol Dial Transplant,2006,21(8):2247-2255.