Renal replacement therapy intensity for acute kidney injury and recovery to dialysis independence

a systematic review and individual patient data meta-analysis

Ying Wang, Martin Gallagher, Qiang Li, Serigne Lo, Alan Cass, Simon Finfer, John Myburgh, Catherine Bouman, Robert Faulhaber-Walter, John A. Kellum, Paul M. Palevsky, Claudio Ronco, Patrick Saudan, Ashita Tolwani, Rinaldo Bellomo*

*Corresponding author for this work

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background. There is no consensus whether higher intensity dose renal replacement therapy (RRT) compared with standard intensity RRT has survival benefit and achieves better renal recovery in acute kidney injury (AKI). Methods. In an individual patient data meta-analysis, we merged individual patient data from randomized controlled trials (RCTs) comparing high with standard intensity RRT in intensive care unit patients with severe AKI. The primary outcome was all-cause mortality. The secondary outcome was renal recovery assessed as the proportion of patients who were RRT dependent at key trial endpoints and by time to the end of RRT dependence. Results. Of the eight prospective RCTs assessing different RRT intensities, seven contributed individual patient data (n = 3682) to the analysis. Mortality was similar between the two groups at 28 days [769/1884 (40.8%) and 744/1798 (41.4%), respectively; P = 0.40] after randomization. However, more participants assigned to higher intensity therapy remained RRT dependent at the most common key study point of 28 days [e.g. 292/983 (29.7%) versus 235/943 (24.9%); relative risk 1.15 (95% confidence interval 1.00-1.33); P = 0.05]. Time to cessation of RRT through 28 days was longer in patients receiving higher intensity RRT (log-rank test P = 0.02) and when continuous renal replacement therapy was used as the initial modality of RRT (log-rank test P = 0.03). Conclusions. In severe AKI patients, higher intensity RRT does not affect mortality but appears to delay renal recovery. Trial Registration. Australian New Zealand Clinical Trials Registry (ANZCTR) identifier ACTRN12615000394549 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615000394549).

Original languageEnglish
Pages (from-to)1017-1024
Number of pages8
JournalNephrology Dialysis Transplantation
Volume33
Issue number6
DOIs
Publication statusPublished - 1 Jun 2018
Externally publishedYes

Keywords

  • all-cause mortality
  • continuous RRT
  • intermittent RRT
  • renal recovery
  • renal replacement therapy dose intensity

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