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 -