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Evidence summaries

Intermittent Versus Continuous and Intensity of Continuous Renal Replacement Therapy for Acute Kidney Injury in Adults

Intermittent renal replacement therapy appears to be as effective as continuous renal replacement therapy for acute kidney injury in adults. Moreover, more intensive continuous renal replacement therapy appears to be as effective as less intensive therapy. Level of evidence: "B"

A meta-analysis 3 included 21 studies with a total of 5015 patients. There was no difference in hospital mortality between continuous renal replacement therapy (CRRT) vs intermittent haemodialysis (IHD) (RR 1.00, 95% CI 0.92 to 1.09; 7 RCTs, n=1423), between CRRT vs sustained low efficiency dialysis (SLED) (RR 1.23, 95% CI 1.00 to 1.51; 5 RCTs, n=394). Neither were there differences in dialysis dependence between different modalities.

A Cochrane review [Abstract] 2 included 6 studies with a total of 3 185 critically ill patients with acute kidney injury. There was no significant difference between intensive versus less intensive continuous renal replacement therapy (CRRT) on risk of mortality or recovery of kidney function (T1).

A Cochrane review [Abstract] 1 included 15 studies with a total of 1550 patients. Continuous renal replacement therapy (CRRT) did not differ from intermittent renal replacement therapy (IRRT) with respect to in-hospital mortality (RR 1.01, 95% CI 0.92 to 1.12, 7 studies, n=1245), intensive care unit mortality, number of surviving patients not requiring renal replacement therapy, haemodynamic instability or hypotension and need for escalation of pressor therapy. Patients on CRRT were likely to have higher mean arterial pressure (WMD 5.35, 95% CI 1.41 to 9.29) and higher risk of clotting dialysis filters (RR 8.50, CI 1.14 to 63.33, 3 trials, n=149).

Intensive versus less intensive continuous renal replacement therapy (CRRT) for acute kidney injury

OutcomeRelative effect(95% CI)Assumed risk - Control - Less intensive CRRTCorresponding risk Intensive CRRT (95% CI)No. of participants(studies) Quality of evidence
Mortality at day 30RR 0.88 (0.81 to 1.1)430 per 1000420 per 1000(412 to 523)2402 (5) Low
Mortality after 30 days Follow-up: 60 daysRR 0.92 (0.80 to 1.06)514 per 1000483 per 1000(416 to 565)2402 (5) Low
Patients free of renal replacement therapy after discontinuing CRRTFollow-up: 90 daysRR 0.98 (0.94 to 1.01)923 per 1000904 per 1000(867 to 932)988 (3) Moderate
Adverse events: hypophosphataemiaRR 1.21 (1.11 to 1.31)540 per 1000654 per 1000(600 to 708)1441 (1) High

Comment: The costs for IRRT are much less than the costs for CRRT.

References

  • Rabindranath K, Adams J, Macleod AM, Muirhead N. Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database Syst Rev 2007 Jul 18;(3):CD003773. [PubMed]
  • Fayad AI, Buamscha DG, Ciapponi A. Intensity of continuous renal replacement therapy for acute kidney injury. Cochrane Database Syst Rev 2016;(10):CD010613. [PubMed]
  • NashDM, Przech S, Wald R et al. Systematic review and meta-analysis of renal replacement therapy modalities for acute kidney injury in the intensive care unit. J Crit Care 2017;(41):138-144. [PubMed]

Primary/Secondary Keywords