目的 系统评价慢性肾脏病和血液透析伴高钾血症患者使用环硅酸锆钠的有效性和安全性,以期为环硅酸锆钠治疗高钾血症的临床使用提供参考.方法 检索中国知网、中国生物医学文献数据库、维普数据库、万方数据库、Cochrane Library、PubMed、Embase、Web of Science,收集环硅酸锆钠治疗高钾血症的随机对照试验.检索时间为各数据库建库至2023年7月1日.对符合入选和排除标准的文献采用R4.3.1统计软件进行meta分析.结果 共纳入11篇文献,包括1321例患者,试验组664例,对照组657例,meta分析结果显示,与安慰剂或低钾饮食组相比,环硅酸锆钠组的降钾效果显著[MD=-0.67,95％CI(-0.80～-0.54)],亚组分析显示在亚洲人群中环硅酸锆钠降低血钾的效果较好[MD=-0.76,95％CI(-0.98～-0.55)].对其他电解质水平的影响,两组差异无统计学意义[MD=0.01,95％CI(-0.04～0.05)];两组便秘、胃肠道反应和外周水肿发生率差异无统计学意义;环硅酸锆钠组低钾血症的发生率大于安慰剂或低钾饮食组[RR=5.93,95％CI(1.46～24.04)].结论 环硅酸锆钠能够显著降低高钾血症患者体内的血钾值,在亚洲人群当中效果同样显著,并且不影响其他电解质水平,不良反应发生率较低,但可能会出现低钾血症.
Efficacy and safety of sodium zirconium cyclosilicate for chronic kidney disease with hyperkalemia and hemodialysis with hyperkalemia:a meta-analysis
Objective To systematically evaluate the efficacy and safety of sodium zirconium cyclosilicate in patients with chronic kidney disease with hyperkalemia and hemodialysis with hyperkalemia,to provide reference for clinical use of sodium zirconium cyclosilicate.Methods CNKI,China Biology Medicine disc,VIP database,Wanfang database,Cochrane Library,PubMed,EMbase and Web of Science were searched to collect randomized controlled trials of sodium zirconium cyclosilicate for hyperkalemia.Literatures from the establishment of each database to July 1st,2023 were included and searched.R 4.3.1 was used for meta-analysis of the literatures that met the inclusion and exclusion criteria.Results Totally 11 literatures were included,involving 1321 patients(664 in the experimental group and 657 in the control group).The meta-analysis showed that compared with placebo or low-potassium diet group,sodium zirconium cyclosilicate group had a significant potassium reduction effect[MD=-0.67,95％CI(-0.80～-0.54)].Subgroup analysis showed that sodium zirconium cyclo better reduced blood potassium in Asian population[MD=-0.76,95％CI(-0.98～-0.55)].There was no significant effect on the level of other electrolytes between the two groups[MD=0.01,95％CI(-0.04～0.05)].The incidence of constipation,gastrointestinal reaction and peripheral edema were not significantly different between the two groups.The incidence of hypokalemia was higher in the sodium zirconium cyclo silicate group than in the placebo or low-potassium diet group[RR=5.93,95％CI(1.46～24.04)].Conclusion Sodium zirconium cyclosilicate can significantly reduce the serum potassium value in patients with hyperkalemia.The effect is significant in Asian population,but it does not affect the level of other electrolytes.The incidence of adverse reactions is low,which may lead to hypokalemia.
万方数据
维普
