title: Intensities of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Clinical trials of the intensity of renal replacement therapy (RRT) for people with acute kidney injury (AKI) have produced conflicting results. A systematic review and meta-analysis was undertaken to assess the effect of different intensities of RRT on all-cause mortality and renal recovery in AKI patients.
  
  
  METHODS
  MEDLINE, EMBASE, and the Cochrane Library database were systematically searched for trials published between 1950 and 2009. Inclusion criteria were completed, prospective, adult-population, randomized controlled studies. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated. Summary estimates of RR were obtained using a random effects model. Heterogeneity, metaregression, publication bias, and subgroup analyses were conducted.
  
  
  RESULTS
  Eight trials were identified that provided data on 3841 patients and 1808 deaths. More intense RRT (35 to 48 ml/kg per h or equivalent) had no overall effect on the risk of death (RR 0.89, 95% CI 0.76 to 1.04, P = 0.143) or recovery of renal function (RR 1.12, 95% CI 0.95 to 1.31, P = 0.181) compared with less-intensive regimens (20 to 25 ml/kg per h or equivalent). Significant heterogeneity was identified with contributing factors including publication year (P = 0.004) and Jadad score (P = 0.048).
  
  
  CONCLUSIONS
  Within the intensity ranges studied, higher intensity RRT does not reduce mortality rates or improve renal recovery among patients with AKI. The results do not negate the importance of RRT intensity in the treatment of AKI patients but rather reinforce the need to better understand the effects of treatment modalities, doses, and timing in this varied, high-risk population.
authors.affiliation: The George Institute for International Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Min
authors.initials: M
authors.lastname: Jun
authors.forename: Hiddo J Lambers
authors.initials: HJ
authors.lastname: Heerspink
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ninomiya
authors.forename: Martin
authors.initials: M
authors.lastname: Gallagher
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: John
authors.initials: J
authors.lastname: Myburgh
authors.forename: Simon
authors.initials: S
authors.lastname: Finfer
authors.forename: Paul M
authors.initials: PM
authors.lastname: Palevsky
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
authors.forename: Vlado
authors.initials: V
authors.lastname: Perkovic
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
mesh_terms: D000208:Acute Disease; D000368:Aged; D001835:Body Weight; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
references.citation: JAMA. 2005 Aug 17;294(7):813-8
references.pmid: 16106006
references.citation: J Am Soc Nephrol. 2006 Apr;17(4):1143-50
references.pmid: 16495376
references.citation: Kidney Int. 2006 Oct;70(7):1312-7
references.pmid: 16850022
references.citation: N Engl J Med. 2008 Jul 3;359(1):7-20
references.pmid: 18492867
references.citation: Open Med. 2009;3(3):e123-30
references.pmid: 21603045
references.citation: J Am Soc Nephrol. 2007 Apr;18(4):1292-8
references.pmid: 17314324
references.citation: N Engl J Med. 2002 Jan 31;346(5):305-10
references.pmid: 11821506
references.citation: JAMA. 2002 Jun 5;287(21):2801-4
references.pmid: 12038917
references.citation: BMJ. 1997 Sep 13;315(7109):629-34
references.pmid: 9310563
references.citation: J Am Soc Nephrol. 2008 Jun;19(6):1233-8
references.pmid: 18337480
references.citation: Crit Care Med. 2002 Oct;30(10):2205-11
references.pmid: 12394945
references.citation: Pain. 1996 Aug;66(2-3):239-46
references.pmid: 8880846
references.citation: Nephrol Dial Transplant. 2009 Jul;24(7):2179-86
references.pmid: 19218540
references.citation: J Trauma. 1975 Dec;15(12):1056-63
references.pmid: 1202238
references.citation: JAMA. 1995 Feb 1;273(5):408-12
references.pmid: 7823387
references.citation: J Clin Epidemiol. 1998 Dec;51(12):1235-41
references.pmid: 10086815
references.citation: N Engl J Med. 2009 Oct 22;361(17):1627-38
references.pmid: 19846848
references.citation: Lancet. 2000 Jul 1;356(9223):26-30
references.pmid: 10892761
references.citation: Crit Care. 2007;11(3):R68
references.pmid: 17588270
references.citation: J Am Soc Nephrol. 2009 Jan;20(1):223-8
references.pmid: 19020007
references.citation: Kidney Int. 2009 Aug;76(4):422-7
references.pmid: 19436332