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

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], I 2 = 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], I 2 = 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.

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Acknowledgments

We thank Drs. Vijayan, Lins, Ahlstrom, Andrikos, Garcia-Fernandes, and Marshall for making data available. This study was funded by the Austin Hospital Anaesthesia and Intensive Care Trust Fund. Preliminary results of this study were presented at the 32nd ISICEM conference and published as an abstract in Critical Care. Dr. Bagshaw is supported by a Canada Research Chair in Critical Care Nephrology and Clinical Investigator Award from Alberta Innovates-Health Solutions.

Conflicts of interest

Drs. Bellomo and Bagshaw have acted as occasional paid consultant for Gambro Pty ltd over the last five years. All other authors stated that they had no conflicts of interest to declare.

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Correspondence to Antoine G. Schneider.

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Schneider, A.G., Bellomo, R., Bagshaw, S.M. et al. Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis. Intensive Care Med 39, 987–997 (2013). https://doi.org/10.1007/s00134-013-2864-5

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Keywords

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