Systematic review and meta-analysis of renal replacement therapy modalities for acute kidney injury in the intensive care unit

Danielle M Nash; Sebastian Przech; Ron Wald; Daria O'Reilly

doi:10.1016/j.jcrc.2017.05.002

Systematic review and meta-analysis of renal replacement therapy modalities for acute kidney injury in the intensive care unit

J Crit Care. 2017 Oct:41:138-144. doi: 10.1016/j.jcrc.2017.05.002. Epub 2017 May 9.

Authors

Danielle M Nash¹, Sebastian Przech², Ron Wald³, Daria O'Reilly⁴

Affiliations

¹ Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, London Health Sciences Centre, London, Ontario, Canada. Electronic address: danielle.nash@lhsc.on.ca.
² Department of Medicine, London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada. Electronic address: sebastian.przech@mail.mcgill.ca.
³ Department of Medicine (Nephrology), St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: waldr@smh.ca.
⁴ Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Programs for Assessment of Technology in Health, St. Josephs' Healthcare Hamilton, Hamilton, Ontario, Canada. Electronic address: oreilld@mcmaster.ca.

PMID: 28525779
DOI: 10.1016/j.jcrc.2017.05.002

Abstract

Purpose: To compare clinical outcomes among critically ill adults with acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT), intermittent hemodialysis (IHD) or sustained low efficiency dialysis (SLED).

Materials and methods: We completed a systematic review and meta-analysis of studies published in 2015 or earlier using MEDLINE®, EMBASE®, Cochrane databases and grey literature. Eligible studies included randomized clinical trials (RCTs) or prospective cohort studies comparing outcomes of mortality, dialysis dependence or length of stay among critically ill adults receiving CRRT, IHD or SLED to treat AKI. Mortality and dialysis dependence from RCTs were pooled using meta-analytic techniques. Length of stay from RCTs and results from prospective cohort studies were described qualitatively.

Results: Twenty-one studies were eligible. RRT modality was not associated with in-hospital mortality (CRRT vs IHD: RR 1.00 [95% CI, 0.92-1.09], CRRT vs SLED: RR 1.23 [95% CI, 1.00-1.51]) or dialysis dependence (CRRT vs IHD: RR 0.90 [95% CI, 0.59-1.38], CRRT vs SLED: RR 1.15 [95% CI, 0.67-1.99]).

Conclusions: We did not find a definitive advantage for any RRT modality on short-term patient or kidney survival. Well-designed, adequately-powered trials are needed to better define the role of RRT modalities for treatment of critically ill patients with AKI.

Keywords: Acute kidney injury; Intensive care; Meta-analysis; Renal replacement therapy; Systematic review.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Acute Kidney Injury / therapy*
Critical Illness / therapy*
Hospital Mortality
Humans
Intensive Care Units / statistics & numerical data*
Prospective Studies
Renal Dialysis / methods
Renal Replacement Therapy / methods*

Grants and funding

347906/Canadian Institutes of Health Research/International