title: Effect of sustained low efficient dialysis versus continuous renal replacement therapy on renal recovery after acute kidney injury in the intensive care unit: A systematic review and meta-analysis.
abstract: Critically ill adults with acute kidney injury (AKI) experience considerable morbidity and mortality. Controversy remains regarding the optimal renal replacement intervention for these patients. Our systematic review aimed to determine the effect(s) of sustained low-efficiency dialysis (SLED) compared with continuous renal replacement (CRRT) therapy on relevant patient outcomes. A systematic search of Medline, Embase, CINAHL and the Cochrane Library was conducted. Identified citations were screened independently in duplicate for relevance, and the methodological quality of included studies was evaluated. Data were extracted on study, patient and intervention characteristics and relevant clinical outcomes. Results were pooled using inverse variance fixed and random effects meta-analysis. A total of 1564 patients from 18 studies were included. Meta-analysis results indicated no statistically significant difference in our primary outcome, overall proportion of renal recovery (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.63-1.20, I2 = 66%). No significant difference was observed for the secondary outcome of time to renal recovery (mean difference 1.33, 95% CI 0.23-2.88, I2 = 0%). Statistically, SLED was marginally favoured over CRRT for the secondary outcome of mortality (RR 1.21, 95% CI 1.02-1.43, I2 = 47%); however, this diminished when sensitivity analysis of only randomized controlled trials was conducted (RR 1.25, 95% CI 1.00-1.57, I2 = 0%). There appears to be no clear for advantage continuous renal replacement in the hemodynamically unstable patient. Currently, both modalities are safe and effective means of treating AKI in the critically ill adult.
authors.affiliation: Department of Medicine, Montfort Hospital, Ottawa, Ontario, Canada.
authors.forename: Bernadett
authors.initials: B
authors.lastname: Kovacs
authors.affiliation: The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Katrina J
authors.initials: KJ
authors.lastname: Sullivan
authors.affiliation: The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Division of Nephrology, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Swapnil
authors.initials: S
authors.lastname: Hiremath
authors.affiliation: The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Rakesh V
authors.initials: RV
authors.lastname: Patel
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D020127:Recovery of Function; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012307:Risk Factors; D016896:Treatment Outcome
keywords: acute renal failure (ARF); dialysis; meta-analysis