Intensity of Continuous Renal Replacement Therapy in Acute Kidney Injury in the Intensive Care Unit: A Systematic Review and Meta-Analysis

• Published in: Vascular and Endovascular Surgery 2011-08, Vol.45 (6), p.504-510
• Main Authors: Negash, Daniel T., Dhingra, Vinay K., Copland, Michael, Griesdale, Donald, Henderson, William
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - mortality; Acute Kidney Injury - therapy; Biological and medical sciences; Critical Illness; Evidence-Based Medicine; Humans; Intensive Care Units; Medical sciences; Odds Ratio; Randomized Controlled Trials as Topic; Renal Replacement Therapy - adverse effects; Renal Replacement Therapy - mortality; Risk Assessment; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Time Factors; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 1538-5744; 1938-9116
• DOI: 10.1177/1538574411407935

Background and Objective: Acute kidney injury is a common finding among patients in the intensive care unit (ICU) and is an independent predictor of mortality. The optimal intensity and timing of continuous renal replacement therapy (CRRT), in critically ill patients remain unclear. The purpose of this study was to conduct a systematic review and meta-analysis of all prospective randomized controlled trials (RCTs) to determine the effect of intensity of CRRT on the survival of patients with acute renal failure (ARF) in ICU setting. Methods: Search strategy and data source. Electronic databases were searched on MEDLINE (through February 2010), ISIWeb of Science, and Cochrane Central Register of Controlled Trials (2010); Pub Med ‘‘Related articles.’’ Trial authors were also contacted for additional information. Study selection and data abstraction. All prospective clinical trials comparing the intensity of CRRT in adult patients with ARF and with explicit reporting of mortality were included. Three authors independently evaluated articles for eligibility and extracted data on study quality and outcomes. Meta-analysis used a random-effects model. Result: Of the 322 citations, 5 trials (n = 2402) were included in the meta-analysis, which met all the inclusion and exclusion criteria. Meta-analysis showed that in critically ill patients with acute kidney injury, the high-dose CRRT did not reduce mortality at 28 days. (risk ratio [RR], 0.88; 95% confidence interval [CI], 0.70-1.11; P = 0.28). Conclusion: In critically ill patients with acute kidney injury, the high-dose CRRT did not reduce mortality at 28 days.