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Title: Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis.
Austin Authors: Schneider, Antoine G;Bellomo, Rinaldo ;Bagshaw, Sean M;Glassford, Neil J;Lo, Serigne;Jun, Min;Cass, Alan;Gallagher, Martin
Affiliation: Intensive Care Unit, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia
Issue Date: 27-Feb-2013
Publication information: Intensive Care Medicine 2013; 39(6): 987-97
Abstract: 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)].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.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).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.
Gov't Doc #: 23443311
DOI: 10.1007/s00134-013-2864-5
Journal: Intensive Care Medicine
Type: Journal Article
Subjects: Acute Kidney Injury.therapy
Decision Making
Outcome and Process Assessment (Health Care)
Renal Dialysis
Renal Replacement Therapy.methods
Risk Factors
Appears in Collections:Journal articles

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