Extended Daily Dialysis Versus Continuous Renal Replacement Therapy for Acute Kidney Injury: A Meta-analysis

Ling Zhang, Jiqiao Yang, Glenn M. Eastwood, Guijun Zhu, Aiko Tanaka, Rinaldo Bellomo

Research output: Contribution to journalArticleResearchpeer-review

54 Citations (Scopus)

Abstract

Background Extended daily dialysis (EDD) has been suggested as an effective renal replacement therapy for acute kidney injury. However, results from studies comparing EDD to continuous renal replacement therapy (CRRT) are inconclusive. Study Design A systematic review and meta-analysis was performed by searching in MEDLINE, EMBASE, the Cochrane Library, Google Scholar, and a Chinese database (SinsoMed). Setting & Population Patients with acute kidney injury. Selection Criteria for Studies Randomized controlled trials (RCTs) and observational studies were included. EDD was defined as extended hemodialysis or hemodiafiltration for more than 6 but less than 24 hours per session using a conventional hemodialysis machine. Intervention Renal replacement therapy comparing EDD with CRRT. Outcomes Mortality, kidney recovery, and fluid removal. Results We included 17 studies from 2000 to 2014: 7 RCTs and 10 observational studies involving 533 and 675 patients, respectively. Meta-analysis of RCTs showed no difference in mortality rates between EDD and CRRT (relative risk, 0.90; 95% CI, 0.74-1.11; P = 0.3). However, EDD was associated with lower mortality risk compared with CRRT in observational studies (relative risk, 0.86; 95% CI, 0.74-1.00; P = 0.05). There was no evidence of heterogeneity in RCTs (I2 = 0%) or observational studies (I2 = 15%). In both RCTs and observational studies, there were no significant differences in recovery of kidney function, fluid removal, or days in the intensive care unit, and EDD showed similar biochemical efficacy to CRRT during treatment (serum urea, serum creatinine, and serum phosphate). Limitations The survival benefit of EDD is dependent on only observational studies and might have been affected by allocation or selection bias. Conclusions EDD is associated with similar outcomes to CRRT in RCTs. The finding that EDD is associated with a lower mortality rate relies on data from observational studies, which are potentially subject to allocation or selection bias, making further high-quality RCTs desirable.

Original languageEnglish
Pages (from-to)322-330
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume66
Issue number2
DOIs
Publication statusPublished - Aug 2015
Externally publishedYes

Keywords

  • acute kidney injury (AKI)
  • acute renal failure (ARF)
  • continuous renal replacement therapy (CRRT)
  • fluid removal
  • hemodiafiltration
  • hemofiltration
  • Index Words Extended daily dialysis (EDD)
  • kidney recovery
  • meta-analysis
  • mortality
  • prolonged intermittent dialysis
  • sustained low-efficiency dialysis/diafiltration (SLED), hemodialysis

Cite this

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title = "Extended Daily Dialysis Versus Continuous Renal Replacement Therapy for Acute Kidney Injury: A Meta-analysis",
abstract = "Background Extended daily dialysis (EDD) has been suggested as an effective renal replacement therapy for acute kidney injury. However, results from studies comparing EDD to continuous renal replacement therapy (CRRT) are inconclusive. Study Design A systematic review and meta-analysis was performed by searching in MEDLINE, EMBASE, the Cochrane Library, Google Scholar, and a Chinese database (SinsoMed). Setting & Population Patients with acute kidney injury. Selection Criteria for Studies Randomized controlled trials (RCTs) and observational studies were included. EDD was defined as extended hemodialysis or hemodiafiltration for more than 6 but less than 24 hours per session using a conventional hemodialysis machine. Intervention Renal replacement therapy comparing EDD with CRRT. Outcomes Mortality, kidney recovery, and fluid removal. Results We included 17 studies from 2000 to 2014: 7 RCTs and 10 observational studies involving 533 and 675 patients, respectively. Meta-analysis of RCTs showed no difference in mortality rates between EDD and CRRT (relative risk, 0.90; 95{\%} CI, 0.74-1.11; P = 0.3). However, EDD was associated with lower mortality risk compared with CRRT in observational studies (relative risk, 0.86; 95{\%} CI, 0.74-1.00; P = 0.05). There was no evidence of heterogeneity in RCTs (I2 = 0{\%}) or observational studies (I2 = 15{\%}). In both RCTs and observational studies, there were no significant differences in recovery of kidney function, fluid removal, or days in the intensive care unit, and EDD showed similar biochemical efficacy to CRRT during treatment (serum urea, serum creatinine, and serum phosphate). Limitations The survival benefit of EDD is dependent on only observational studies and might have been affected by allocation or selection bias. Conclusions EDD is associated with similar outcomes to CRRT in RCTs. The finding that EDD is associated with a lower mortality rate relies on data from observational studies, which are potentially subject to allocation or selection bias, making further high-quality RCTs desirable.",
keywords = "acute kidney injury (AKI), acute renal failure (ARF), continuous renal replacement therapy (CRRT), fluid removal, hemodiafiltration, hemofiltration, Index Words Extended daily dialysis (EDD), kidney recovery, meta-analysis, mortality, prolonged intermittent dialysis, sustained low-efficiency dialysis/diafiltration (SLED), hemodialysis",
author = "Ling Zhang and Jiqiao Yang and Eastwood, {Glenn M.} and Guijun Zhu and Aiko Tanaka and Rinaldo Bellomo",
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Extended Daily Dialysis Versus Continuous Renal Replacement Therapy for Acute Kidney Injury : A Meta-analysis. / Zhang, Ling; Yang, Jiqiao; Eastwood, Glenn M.; Zhu, Guijun; Tanaka, Aiko; Bellomo, Rinaldo.

In: American Journal of Kidney Diseases, Vol. 66, No. 2, 08.2015, p. 322-330.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Extended Daily Dialysis Versus Continuous Renal Replacement Therapy for Acute Kidney Injury

T2 - A Meta-analysis

AU - Zhang, Ling

AU - Yang, Jiqiao

AU - Eastwood, Glenn M.

AU - Zhu, Guijun

AU - Tanaka, Aiko

AU - Bellomo, Rinaldo

PY - 2015/8

Y1 - 2015/8

N2 - Background Extended daily dialysis (EDD) has been suggested as an effective renal replacement therapy for acute kidney injury. However, results from studies comparing EDD to continuous renal replacement therapy (CRRT) are inconclusive. Study Design A systematic review and meta-analysis was performed by searching in MEDLINE, EMBASE, the Cochrane Library, Google Scholar, and a Chinese database (SinsoMed). Setting & Population Patients with acute kidney injury. Selection Criteria for Studies Randomized controlled trials (RCTs) and observational studies were included. EDD was defined as extended hemodialysis or hemodiafiltration for more than 6 but less than 24 hours per session using a conventional hemodialysis machine. Intervention Renal replacement therapy comparing EDD with CRRT. Outcomes Mortality, kidney recovery, and fluid removal. Results We included 17 studies from 2000 to 2014: 7 RCTs and 10 observational studies involving 533 and 675 patients, respectively. Meta-analysis of RCTs showed no difference in mortality rates between EDD and CRRT (relative risk, 0.90; 95% CI, 0.74-1.11; P = 0.3). However, EDD was associated with lower mortality risk compared with CRRT in observational studies (relative risk, 0.86; 95% CI, 0.74-1.00; P = 0.05). There was no evidence of heterogeneity in RCTs (I2 = 0%) or observational studies (I2 = 15%). In both RCTs and observational studies, there were no significant differences in recovery of kidney function, fluid removal, or days in the intensive care unit, and EDD showed similar biochemical efficacy to CRRT during treatment (serum urea, serum creatinine, and serum phosphate). Limitations The survival benefit of EDD is dependent on only observational studies and might have been affected by allocation or selection bias. Conclusions EDD is associated with similar outcomes to CRRT in RCTs. The finding that EDD is associated with a lower mortality rate relies on data from observational studies, which are potentially subject to allocation or selection bias, making further high-quality RCTs desirable.

AB - Background Extended daily dialysis (EDD) has been suggested as an effective renal replacement therapy for acute kidney injury. However, results from studies comparing EDD to continuous renal replacement therapy (CRRT) are inconclusive. Study Design A systematic review and meta-analysis was performed by searching in MEDLINE, EMBASE, the Cochrane Library, Google Scholar, and a Chinese database (SinsoMed). Setting & Population Patients with acute kidney injury. Selection Criteria for Studies Randomized controlled trials (RCTs) and observational studies were included. EDD was defined as extended hemodialysis or hemodiafiltration for more than 6 but less than 24 hours per session using a conventional hemodialysis machine. Intervention Renal replacement therapy comparing EDD with CRRT. Outcomes Mortality, kidney recovery, and fluid removal. Results We included 17 studies from 2000 to 2014: 7 RCTs and 10 observational studies involving 533 and 675 patients, respectively. Meta-analysis of RCTs showed no difference in mortality rates between EDD and CRRT (relative risk, 0.90; 95% CI, 0.74-1.11; P = 0.3). However, EDD was associated with lower mortality risk compared with CRRT in observational studies (relative risk, 0.86; 95% CI, 0.74-1.00; P = 0.05). There was no evidence of heterogeneity in RCTs (I2 = 0%) or observational studies (I2 = 15%). In both RCTs and observational studies, there were no significant differences in recovery of kidney function, fluid removal, or days in the intensive care unit, and EDD showed similar biochemical efficacy to CRRT during treatment (serum urea, serum creatinine, and serum phosphate). Limitations The survival benefit of EDD is dependent on only observational studies and might have been affected by allocation or selection bias. Conclusions EDD is associated with similar outcomes to CRRT in RCTs. The finding that EDD is associated with a lower mortality rate relies on data from observational studies, which are potentially subject to allocation or selection bias, making further high-quality RCTs desirable.

KW - acute kidney injury (AKI)

KW - acute renal failure (ARF)

KW - continuous renal replacement therapy (CRRT)

KW - fluid removal

KW - hemodiafiltration

KW - hemofiltration

KW - Index Words Extended daily dialysis (EDD)

KW - kidney recovery

KW - meta-analysis

KW - mortality

KW - prolonged intermittent dialysis

KW - sustained low-efficiency dialysis/diafiltration (SLED), hemodialysis

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DO - 10.1053/j.ajkd.2015.02.328

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