The dose of continuous renal replacement therapy for acute renal failure: a systematic review and meta-analysis.
OBJECTIVE
To conduct a systematic review of the literature to summarize the best available evidence regarding the mortality and morbidity associated with differing dosing regimens of continuous renal replacement therapy (CRRT) for patients with acute renal failure (ARF) in an intensive care unit setting.


METHODS
We searched for randomized controlled trials in electronic databases from January 1990 through November 2009. Eligible trials compared two or more dosing regimens of CRRT in patients with ARF. Two reviewers working independently determined trial eligibility and extracted descriptive, methodological, and outcome data. Random-effects meta-analysis was used to assess relative risks (RR) and weighted mean difference. The I(2)-statistic was used to assess heterogeneity of treatment effect across trials.


RESULTS
Seven trials were eligible for meta-analysis. We found no reduction in mortality in patients who received higher doses of CRRT (RR 0.88, 95% CI 0.75-1.03, I(2) = 74%). There was no difference in the requirement of renal replacement therapy at the conclusion of the study period (RR 1.12, 95% CI 0.86-1.46, I(2) = 3%). The overall quality of evidence was downgraded because of imprecision and heterogeneity.


CONCLUSIONS
Increased dosing of CRRT is not associated with a decrease in mortality of patients with ARF in an intensive care unit setting.
Casey
Edward T
ET
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA. mail: casey.edward@mayo.edu
Gupta
Bhanu P
BP
Erwin
Patricia J
PJ
Montori
Victor M
VM
Murad
M Hassan
MH
D058186:Acute Kidney Injury / Q000628:therapy*; D006801:Humans; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000379:methods / Q000401:mortality*