Intensive- vs less-intensive-dose continuous renal replacement therapy for the intensive care unit-related acute kidney injury: a meta-analysis and systematic review.
OBJECTIVE
The aim of the study is to summarize the effect of intensive-dose continuous renal replacement therapy (CRRT) on the mortality and other clinical outcomes.


METHODS
A systematic search for randomized, controlled trials (RCTs) was performed. We estimated pooled relative ratios and 95% confidence intervals using fixed effects model or random effects model as appropriate.


RESULTS
We analyzed data extracted from 6 RCTs comparing the effects of intensive and less intensive dose of RRT on clinical outcomes. A total of 3490 patients were included, including 1803 patients received intensive CRRT doses and 1687 received less-intensive doses. Overall, 44.5% (802/1803) patients died in the intensive dose group compared with 45.4% (766/1687) in the dose group, with the risk ratio of 0.91 (95% confidence interval: 0.77-1.08). The heterogeneity was remarkable (I(2) = 75%), and the subgroup analysis limited to patients with sepsis failed to find a reason for the heterogeneity. The intensive dose showed no beneficial effects on other clinical outcomes, and the complications associated with RRT were higher in the intensive dose group.


CONCLUSIONS
This meta-analysis provides additional evidence that the higher dose of CRRT is not sufficient in reducing the mortality in critically ill patients with acute renal failure.
Zhang
Zhongheng
Z
Intensive Care Unit of Jinhua Central Hospital, Zhejiang 321000, China. zh_zhang1984@hotmail.com
Xu
Xiao
X
Zhu
Hongyang
H
D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic; D017582:Renal Replacement Therapy / Q000379:methods*; D016896:Treatment Outcome