Renal replacement therapy intensity for acute kidney injury and recovery to dialysis independence: a systematic review and individual patient data meta-analysis.
- Wang Y Renal and Metabolic Division, George Institute for Global Health, Camperdown, NSW, Australia.
- Gallagher M Renal and Metabolic Division, George Institute for Global Health, Camperdown, NSW, Australia.
- Li Q Renal and Metabolic Division, George Institute for Global Health, Camperdown, NSW, Australia.
- Lo S Concord Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
- Cass A Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
- Finfer S Renal and Metabolic Division, George Institute for Global Health, Camperdown, NSW, Australia.
- Myburgh J Renal and Metabolic Division, George Institute for Global Health, Camperdown, NSW, Australia.
- Bouman C Adult Intensive Care Unit, Academic Medical Center, Amsterdam, The Netherlands.
- Faulhaber-Walter R Department of Medicine, Division of Nephrology and Hypertension, Hanover Medical School, Hannover, Germany.
- Kellum JA Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Palevsky PM Veterans Administration Pittsburgh Healthcare System and Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Ronco C Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy.
- Saudan P Division of Nephrology, University Hospital, Zurich, Switzerland.
- Tolwani A Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Bellomo R Renal and Metabolic Division, George Institute for Global Health, Camperdown, NSW, Australia.
- 2017-11-30
Published in:
- Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. - 2018
Acute Kidney Injury
Humans
Randomized Controlled Trials as Topic
Recovery of Function
Renal Dialysis
Renal Replacement Therapy
English
Background
There is no consensus whether higher intensity dose renal replacement therapy (RRT) compared with standard intensity RRT has survival benefit and achieves better renal recovery in acute kidney injury (AKI).
Methods
In an individual patient data meta-analysis, we merged individual patient data from randomized controlled trials (RCTs) comparing high with standard intensity RRT in intensive care unit patients with severe AKI. The primary outcome was all-cause mortality. The secondary outcome was renal recovery assessed as the proportion of patients who were RRT dependent at key trial endpoints and by time to the end of RRT dependence.
Results
Of the eight prospective RCTs assessing different RRT intensities, seven contributed individual patient data (n = 3682) to the analysis. Mortality was similar between the two groups at 28 days [769/1884 (40.8%) and 744/1798 (41.4%), respectively; P = 0.40] after randomization. However, more participants assigned to higher intensity therapy remained RRT dependent at the most common key study point of 28 days [e.g. 292/983 (29.7%) versus 235/943 (24.9%); relative risk 1.15 (95% confidence interval 1.00-1.33); P = 0.05]. Time to cessation of RRT through 28 days was longer in patients receiving higher intensity RRT (log-rank test P = 0.02) and when continuous renal replacement therapy was used as the initial modality of RRT (log-rank test P = 0.03).
Conclusions
In severe AKI patients, higher intensity RRT does not affect mortality but appears to delay renal recovery.
Trial Registration
Australian New Zealand Clinical Trials Registry (ANZCTR) identifier ACTRN12615000394549 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615000394549).
There is no consensus whether higher intensity dose renal replacement therapy (RRT) compared with standard intensity RRT has survival benefit and achieves better renal recovery in acute kidney injury (AKI).
Methods
In an individual patient data meta-analysis, we merged individual patient data from randomized controlled trials (RCTs) comparing high with standard intensity RRT in intensive care unit patients with severe AKI. The primary outcome was all-cause mortality. The secondary outcome was renal recovery assessed as the proportion of patients who were RRT dependent at key trial endpoints and by time to the end of RRT dependence.
Results
Of the eight prospective RCTs assessing different RRT intensities, seven contributed individual patient data (n = 3682) to the analysis. Mortality was similar between the two groups at 28 days [769/1884 (40.8%) and 744/1798 (41.4%), respectively; P = 0.40] after randomization. However, more participants assigned to higher intensity therapy remained RRT dependent at the most common key study point of 28 days [e.g. 292/983 (29.7%) versus 235/943 (24.9%); relative risk 1.15 (95% confidence interval 1.00-1.33); P = 0.05]. Time to cessation of RRT through 28 days was longer in patients receiving higher intensity RRT (log-rank test P = 0.02) and when continuous renal replacement therapy was used as the initial modality of RRT (log-rank test P = 0.03).
Conclusions
In severe AKI patients, higher intensity RRT does not affect mortality but appears to delay renal recovery.
Trial Registration
Australian New Zealand Clinical Trials Registry (ANZCTR) identifier ACTRN12615000394549 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615000394549).
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1093/ndt/gfx308
- PMID 29186517
- Persistent URL
- https://sonar.ch/global/documents/47423
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