title: Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Choice of renal replacement therapy (RRT) modality may affect renal recovery after acute kidney injury (AKI). We sought to compare the rate of dialysis dependence among severe AKI survivors according to the choice of initial renal replacement therapy (RRT) modality applied [continuous (CRRT) or intermittent (IRRT)].
  
  
  METHODS
  Systematic searches of peer-reviewed publications in MEDLINE and EMBASE were performed (last update July 2012). All studies published after 2000 reporting dialysis dependence among survivors from severe AKI requiring RRT were included. Data on follow-up duration, sex, age, chronic kidney disease, illness severity score, vasopressors, and mechanical ventilation were extracted when available. Results were pooled using a random-effects model.
  
  
  RESULTS
  We identified 23 studies: seven randomized controlled trials (RCTs) and 16 observational studies involving 472 and 3,499 survivors, respectively. Pooled analyses of RCTs showed no difference in the rate of dialysis dependence among survivors (relative risk, RR 1.15 [95 % confidence interval (CI) 0.78-1.68], I(2) = 0 %). However, pooled analyses of observational studies suggested a higher rate of dialysis dependence among survivors who initially received IRRT as compared with CRRT (RR 1.99 [95 % CI 1.53-2.59], I (2) = 42 %). These findings were consistent with adjusted analyses (performed in 7/16 studies), which found a higher rate of dialysis dependence in IRRT-treated patients [odds ratio (OR) 2.2-25 (5 studies)] or no difference (2 studies).
  
  
  CONCLUSIONS
  Among AKI survivors, initial treatment with IRRT might be associated with higher rates of dialysis dependence than CRRT. However, this finding largely relies on data from observational trials, potentially subject to allocation bias, hence further high-quality studies are necessary.
authors: Intensive Care Unit, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia. antoine.schneider@austin.org.au
authors: Antoine G
authors: AG
authors: Schneider
authors: Rinaldo
authors: R
authors: Bellomo
authors: Sean M
authors: SM
authors: Bagshaw
authors: Neil J
authors: NJ
authors: Glassford
authors: Serigne
authors: S
authors: Lo
authors: Min
authors: M
authors: Jun
authors: Alan
authors: A
authors: Cass
authors: Martin
authors: M
authors: Gallagher
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D003657:Decision Making; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D006435:Renal Dialysis; D017582:Renal Replacement Therapy / Q000379:methods*; D012307:Risk Factors