Abstract
| Original language | English |
|---|---|
| Pages (from-to) | 987-997 |
| Number of pages | 11 |
| Journal | Intensive Care Medicine |
| Volume | 39 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 2013 |
Keywords
- Acute Kidney Injury/*therapy Decision Making Humans *Outcome and Process Assessment (Health Care) Renal Dialysis Renal Replacement Therapy/*methods Risk Factors
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Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis : Intensive Care Med. / Schneider, Antoine; Bellomo, Rinaldo; Bagshaw, Sean M; Glassford, Neil John; Lo, Serigne; Jun, Min; Cass, Alan; Gallagher, Martin.
In: Intensive Care Medicine, Vol. 39, No. 6, 2013, p. 987-997.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis
T2 - Intensive Care Med
AU - Schneider, Antoine
AU - Bellomo, Rinaldo
AU - Bagshaw, Sean M
AU - Glassford, Neil John
AU - Lo, Serigne
AU - Jun, Min
AU - Cass, Alan
AU - Gallagher, Martin
PY - 2013
Y1 - 2013
N2 - Choice of renal replacement therapy (RRT) modality may affect renal recovery after acute kidney injury (AKI). We sought to compare the rate of dialysis dependence among severe AKI survivors according to the choice of initial renal replacement therapy (RRT) modality applied [continuous (CRRT) or intermittent (IRRT)]. Methods: Systematic searches of peer-reviewed publications in MEDLINE and EMBASE were performed (last update July 2012). All studies published after 2000 reporting dialysis dependence among survivors from severe AKI requiring RRT were included. Data on follow-up duration, sex, age, chronic kidney disease, illness severity score, vasopressors, and mechanical ventilation were extracted when available. Results were pooled using a random-effects model. Results: We identified 23 studies: seven randomized controlled trials (RCTs) and 16 observational studies involving 472 and 3,499 survivors, respectively. Pooled analyses of RCTs showed no difference in the rate of dialysis dependence among survivors (relative risk, RR 1.15 [95 confidence interval (CI) 0.78?1.68], I2 = 0 ). However, pooled analyses of observational studies suggested a higher rate of dialysis dependence among survivors who initially received IRRT as compared with CRRT (RR 1.99 [95 CI 1.53?2.59], I2 = 42 ). These findings were consistent with adjusted analyses (performed in 7/16 studies), which found a higher rate of dialysis dependence in IRRT-treated patients [odds ratio (OR) 2.2?25 (5 studies)] or no difference (2 studies). Conclusions: Among AKI survivors, initial treatment with IRRT might be associated with higher rates of dialysis dependence than CRRT. However, this finding largely relies on data from observational trials, potentially subject to allocation bias, hence further high-quality studies are necessary.
AB - Choice of renal replacement therapy (RRT) modality may affect renal recovery after acute kidney injury (AKI). We sought to compare the rate of dialysis dependence among severe AKI survivors according to the choice of initial renal replacement therapy (RRT) modality applied [continuous (CRRT) or intermittent (IRRT)]. Methods: Systematic searches of peer-reviewed publications in MEDLINE and EMBASE were performed (last update July 2012). All studies published after 2000 reporting dialysis dependence among survivors from severe AKI requiring RRT were included. Data on follow-up duration, sex, age, chronic kidney disease, illness severity score, vasopressors, and mechanical ventilation were extracted when available. Results were pooled using a random-effects model. Results: We identified 23 studies: seven randomized controlled trials (RCTs) and 16 observational studies involving 472 and 3,499 survivors, respectively. Pooled analyses of RCTs showed no difference in the rate of dialysis dependence among survivors (relative risk, RR 1.15 [95 confidence interval (CI) 0.78?1.68], I2 = 0 ). However, pooled analyses of observational studies suggested a higher rate of dialysis dependence among survivors who initially received IRRT as compared with CRRT (RR 1.99 [95 CI 1.53?2.59], I2 = 42 ). These findings were consistent with adjusted analyses (performed in 7/16 studies), which found a higher rate of dialysis dependence in IRRT-treated patients [odds ratio (OR) 2.2?25 (5 studies)] or no difference (2 studies). Conclusions: Among AKI survivors, initial treatment with IRRT might be associated with higher rates of dialysis dependence than CRRT. However, this finding largely relies on data from observational trials, potentially subject to allocation bias, hence further high-quality studies are necessary.
KW - Acute Kidney Injury/therapy Decision Making Humans Outcome and Process Assessment (Health Care) Renal Dialysis Renal Replacement Therapy/methods Risk Factors
UR - http://link.springer.com/content/pdf/10.1007%2Fs00134-013-2864-5.pdf
U2 - 10.1007/s00134-013-2864-5
DO - 10.1007/s00134-013-2864-5
M3 - Article
VL - 39
SP - 987
EP - 997
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
IS - 6
ER -