TY - JOUR
T1 - Intensities of Renal Replacement Therapy in Acute Kidney Injury
T2 - A Systematic Review and Meta-Analysis
AU - Jun, Min
AU - Lambers Heerspink, Hiddo J.
AU - Ninomiya, Toshiharu
AU - Gallagher, Martin
AU - Bellomo, Rinaldo
AU - Myburgh, John
AU - Finfer, Simon
AU - Palevsky, Paul M.
AU - Kellum, John A.
AU - Perkovic, Vlado
AU - Cass, Alan
PY - 2010/6
Y1 - 2010/6
N2 - Background and objectives: Clinical trials of the intensity of renal replacement therapy (RRT) for people with acute kidney injury (AKI) have produced conflicting results. A systematic review and meta-analysis was undertaken to assess the effect of different intensities of RRT on all-cause mortality and renal recovery in AKI patients.Design, setting, participants, & measurements: MEDLINE, EMBASE, and the Cochrane Library database were systematically searched for trials published between 1950 and 2009. Inclusion criteria were completed, prospective, adult-population, randomized controlled studies. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated. Summary estimates of RR were obtained using a random effects model. Heterogeneity, metaregression, publication bias, and subgroup analyses were conducted.Results: Eight trials were identified that provided data on 3841 patients and 1808 deaths. More intense RRT (35 to 48 ml/kg per h or equivalent) had no overall effect on the risk of death (RR 0.89, 95% CI 0.76 to 1.04, P = 0.143) or recovery of renal function (RR 1.12, 95% CI 0.95 to 1.31, P = 0.181) compared with less-intensive regimens (20 to 25 ml/kg per h or equivalent). Significant heterogeneity was identified with contributing factors including publication year (P = 0.004) and Jadad score (P = 0.048).Conclusions: Within the intensity ranges studied, higher intensity RRT does not reduce mortality rates or improve renal recovery among patients with AKI. The results do not negate the importance of RRT intensity in the treatment of AKI patients but rather reinforce the need to better understand the effects of treatment modalities, doses, and timing in this varied, high-risk population. Clin J Am Soc Nephrol 5: 956-963, 2010. doi: 10.2215/CJN.09111209
AB - Background and objectives: Clinical trials of the intensity of renal replacement therapy (RRT) for people with acute kidney injury (AKI) have produced conflicting results. A systematic review and meta-analysis was undertaken to assess the effect of different intensities of RRT on all-cause mortality and renal recovery in AKI patients.Design, setting, participants, & measurements: MEDLINE, EMBASE, and the Cochrane Library database were systematically searched for trials published between 1950 and 2009. Inclusion criteria were completed, prospective, adult-population, randomized controlled studies. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated. Summary estimates of RR were obtained using a random effects model. Heterogeneity, metaregression, publication bias, and subgroup analyses were conducted.Results: Eight trials were identified that provided data on 3841 patients and 1808 deaths. More intense RRT (35 to 48 ml/kg per h or equivalent) had no overall effect on the risk of death (RR 0.89, 95% CI 0.76 to 1.04, P = 0.143) or recovery of renal function (RR 1.12, 95% CI 0.95 to 1.31, P = 0.181) compared with less-intensive regimens (20 to 25 ml/kg per h or equivalent). Significant heterogeneity was identified with contributing factors including publication year (P = 0.004) and Jadad score (P = 0.048).Conclusions: Within the intensity ranges studied, higher intensity RRT does not reduce mortality rates or improve renal recovery among patients with AKI. The results do not negate the importance of RRT intensity in the treatment of AKI patients but rather reinforce the need to better understand the effects of treatment modalities, doses, and timing in this varied, high-risk population. Clin J Am Soc Nephrol 5: 956-963, 2010. doi: 10.2215/CJN.09111209
KW - CRITICALLY-ILL PATIENTS
KW - CONTINUOUS VENOVENOUS HEMOFILTRATION
KW - RANDOMIZED CLINICAL-TRIALS
KW - FAILURE
KW - SURVIVAL
KW - DIALYSIS
KW - QUALITY
KW - RECOVERY
KW - STANDARD
KW - OUTCOMES
U2 - 10.2215/CJN.09111209
DO - 10.2215/CJN.09111209
M3 - Review article
SN - 1555-9041
VL - 5
SP - 956
EP - 963
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 6
ER -