Intensive Care Medicine

, Volume 39, Issue 6, pp 987–997 | Cite as

Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis

  • Antoine G. Schneider
  • Rinaldo Bellomo
  • Sean M. Bagshaw
  • Neil J. Glassford
  • Serigne Lo
  • Min Jun
  • Alan Cass
  • Martin Gallagher
Systematic Review

Abstract

Purpose

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.

Keywords

Hemofiltration Hemodialysis Continuous renal replacement therapy Acute kidney injury Intensive care unit Meta-analysis 

Supplementary material

134_2013_2864_MOESM1_ESM.docx (905 kb)
Supplementary material 1 (DOCX 905 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Antoine G. Schneider
    • 1
    • 2
  • Rinaldo Bellomo
    • 1
    • 2
  • Sean M. Bagshaw
    • 3
  • Neil J. Glassford
    • 1
    • 2
  • Serigne Lo
    • 4
  • Min Jun
    • 4
  • Alan Cass
    • 4
  • Martin Gallagher
    • 4
  1. 1.Intensive Care Unit, Austin HealthHeidelbergAustralia
  2. 2.Australian and New Zealand Research Centre Monash UniversityMelbourneAustralia
  3. 3.Division of Critical Care Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
  4. 4.George Institute for Global HealthUniversity of SydneySydneyAustralia

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