Charles Darwin University

CDU eSpace
Institutional Repository

 
CDU Staff and Student only
 

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

Schneider, Antoine, Bellomo, Rindaldo, Bagshaw, Sean, Glassford, Neil, Lo, Serigne, Jun, Min, Cass, Alan and Gallagher, Martin (2013). Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis. Intensive Care Medicine,39(6):987-997.

Document type: Journal Article

IRMA ID 11035xPUB70
Title Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis
Author Schneider, Antoine
Bellomo, Rindaldo
Bagshaw, Sean
Glassford, Neil
Lo, Serigne
Jun, Min
Cass, Alan
Gallagher, Martin
Journal Name Intensive Care Medicine
Publication Date 2013
Volume Number 39
Issue Number 6
ISSN 0342-4642   (check CDU catalogue  open catalogue search in new window)
Start Page 987
End Page 997
Total Pages 11
Place of Publication Germany
Publisher Springer
HERDC Category C1 - Journal Article (DIISR)
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.
DOI http://dx.doi.org/10.1007/s00134-013-2864-5   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
Versions
Version Filter Type
Access Statistics: 15 Abstract Views  -  Detailed Statistics
Created: Thu, 07 Aug 2014, 16:57:31 CST