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Intensity of continuous renal replacement therapy for acute kidney injury

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References

References to studies included in this review

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ATN Study 2005 {published data only}

Afshinnia F, Belanger K, Palevsky PM, Young EW. Effect of ionized serum calcium on outcomes in acute kidney injury needing renal replacement therapy: secondary analysis of the acute renal failure trial network study. Renal Failure 2013;35(10):1310‐8. [MEDLINE: 23992422]CENTRAL
Crowley S, Schein R, Dev D, Finkel K, Vijayan A, Paganini E, et al. Dialysis catheter complications in the VA/NIH ATN study [abstract no: SA‐PO557]. Journal of the American Society of Nephrology 2007;18(Abstracts):463A. CENTRAL
Crowley S, Schein R, Dev D, Finkel K, Vijayan A, Paganini E, et al. Lessons for successful study enrollment from the VA/NIH ATN study [abstract no: SA‐PO932]. Journal of the American Society of Nephrology 2006;17(Abstracts):770A. [CENTRAL: CN‐00601950]CENTRAL
Crowley ST, Chertow GM, Vitale J, O'Connor T, Zhang J, Schein RM, et al. Lessons for successful study enrollment from the Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network Study. Clinical Journal of The American Society of Nephrology: CJASN 2008;3(4):955‐61. [MEDLINE: 18385390]CENTRAL
Demirjian S, Paganini EP, Zhang JH, O'Connor TZ, Vitale J, Palevsky PM. Severity of illness does not modify the effect of intensity of renal replacement therapy (RRT) on outcome in critically ill patients with AKI: results from the VA/NIH acute renal failure trial network (ATN) study [abstract no: SA‐PO2997]. Journal of the American Society of Nephrology 2008;19(Abstracts Issue):791A. CENTRAL
Demirjian S, Paginini EP, Zhang JH, O'Connor TZ, Vitale J, Palevsky PM, et al. Predictive scoring systems perform poorly in critically ill patients with AKI requiring renal replacement: data from the VA/NIH Acute Renal Failure Trial Network (ATN) study [abstract no: SA‐PO3010]. Journal of the American Society of Nephrology 2008;19(Abstracts Issue):794A. CENTRAL
Johansen KL, Smith MW, Unruh ML, Siroka AM, O'Connor TZ, Palevsky PM, et al. Predictors of health utility among 60‐day survivors of acute kidney injury in the Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network Study. Clinical Journal of The American Society of Nephrology: CJASN 2010 Aug;5(8):1366‐72. [MEDLINE: 20507953]CENTRAL
Joyce VR, Smith MW, Johansen KL, Unruh ML, Siroka AM, O'Connor TZ, et al. Health‐related quality of life as a predictor of mortality among survivors of AKI. Clinical Journal of The American Society of Nephrology: CJASN 2012;7(7):1063‐70. [MEDLINE: 22595826]CENTRAL
Palevsky PM, Franchini R, O'Connor TZ, Zhang JH, VA/NIH Acute Renal Failure Trial Network. Recovery of kidney function in critically ill patients with acute kidney injury (AKI) treated with intensive versus less‐intensive renal replacement therapy (RRT) [abstract no: SA‐PO2994]. Journal of the American Society of Nephrology 2008;19(Abstracts Issue):790A. CENTRAL
Palevsky PM, O'Connor T, Zhang JH, Star RA, Smith MW. Design of the VA/NIH Acute Renal Failure Trial Network (ATN) Study: intensive versus conventional renal support in acute renal failure. Clinical Trials 2005;2(5):423‐35. [MEDLINE: 16317811]CENTRAL
Palevsky PM, O'Connor TZ, Chertow GM, Crowley ST, Zhang JH, Kellum JA, et al. Intensity of renal replacement therapy in acute kidney injury: perspective from within the Acute Renal Failure Trial Network Study. Critical Care (London, England) 2010;13(4):310. [MEDLINE: 19678919]CENTRAL
Palevsky PM, O'Connor TZ, Zhang JH, Star R. VA/NIH Acute Renal Failure Trial: study design [abstract no: SA‐PO970]. Journal of the American Society of Nephrology 2003;14(Program & Abstracts):512A. [CENTRAL: CN‐00583741]CENTRAL
Palevsky PM, Overberger P, Franchini R, O'Connor TZ, Zhang JH, VA/NIH Acute Renal Failure Trial Network. One‐year outcomes in critically ill patients with acute kidney injury (AKI) treated with intensive versus less‐intensive renal replacement therapy (RRT) [abstract no: SA‐FC414]. Journal of the American Society of Nephrology 2008;19(Abstracts Issue):93A. CENTRAL
Palevsky PM, Zhang J, O'Connor T. Intensive versus non‐intensive renal replacement therapy (RRT) in critically ill patients with acute kidney injury (AKI) [abstract]. American Thoracic Society International Conference; 2008 May 16‐21; Toronto, Canada. 2008:A767. [CENTRAL: CN‐00716125]CENTRAL
Pesacreta M, Overberger P, Palevsky PM, VA/NIH Acute Renal Failure Trial Network. Management of renal replacement therapy in acute renal failure: a survey of practitioner prescribing practices. [abstract no: SA‐PO227]. Journal of the American Society of Nephrology 2004;15(Oct):350A. [CENTRAL: CN‐00601951]CENTRAL
VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, O'Connor TZ, Chertow GM, Crowley ST, et al. Intensity of renal support in critically ill patients with acute kidney injury. [Erratum appears in N Engl J Med. 2009 Dec 10;361(24):2391]. New England Journal of Medicine 2008;359(1):7‐20. [MEDLINE: 18492867]CENTRAL
Zhang JH, O'Connor T, Palevsky PM, for the VA/NIH Acute Renal Failure Trial Network Study. Evaluation of treatment separation in the VA/NIH Acute Renal Failure Trial Network (ATN) Study [abstract]. Clinical Trials (London, England) 2009;6(5):523‐4. [CENTRAL: CN‐00783257]CENTRAL
Zhang JH, O'Connor T, Swanson K, Palevsky PM, VA/NIH Acute Renal Failure Trial Network Study. Evaluation of trial safety in an ICU trial: experience from the VA/NIH Acute Renal Failure Trial Network (ATN) Study [abstract]. Clinical Trials (London, England) 2009;6(5):560. [CENTRAL: CN‐00783258]CENTRAL
Zhang JH, Palevsky PM, Chertow GM, Hartigan J, O'Connor TZ, Guarino P, et al. Piecewise analysis of patient survival after onset of AKI. Clinical Journal of The American Society of Nephrology: CJASN 2013;8(10):1679‐84. [MEDLINE: 23813558]CENTRAL

Bouman 2002 {published data only}

Bouman CS, Oudemans‐Van Straaten H, Tijssen JG, Zandstra DF, Kesecioglu J. Effects of early high‐volume continuous venovenous haemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial. Critical Care Medicine 2002;30(10):2205‐11. [MEDLINE: 12394945]CENTRAL

RENAL Study 2006 {published data only}

Bellomo R. Do we know the optimal dose for renal replacement therapy in the intensive care unit?. Kidney International 2006;70(7):1202‐4. [MEDLINE: 16988729]CENTRAL
Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Kim I, et al. The relationship between hypophosphataemia and outcomes during low‐intensity and high‐intensity continuous renal replacement therapy. [Erratum appears in Crit Care Resusc. 2014 Jun;16(2):139 Note: McGuiness, Shay [corrected to McGuinness, Shay]]. Critical Care & Resuscitation 2014;16(1):34‐41. [MEDLINE: 24588434]CENTRAL
Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lee J, et al. Calorie intake and patient outcomes in severe acute kidney injury: findings from The Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial. Critical Care (London, England) 2014;18(2):R45. [MEDLINE: 24629036]CENTRAL
Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lee J, et al. Daily protein intake and patient outcomes in severe acute kidney injury: findings of the randomized evaluation of normal versus augmented level of replacement therapy (RENAL) trial. Blood Purification 2014;37(4):325‐34. [MEDLINE: 25171270]CENTRAL
Bellomo R, Lipcsey M, Calzavacca P, Haase M, Haase‐Fielitz A, Licari E, et al. Early acid‐base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis. Intensive Care Medicine 2013;39(3):429‐36. [MEDLINE: 23306586]CENTRAL
Finfer S, Cass A, Gallagher M, Lee J, Su S, Bellomo R, et al. The RENAL (Randomised Evaluation of Normal vs. Augmented Level of Replacement Therapy) study: statistical analysis plan. Critical Care & Resuscitation 2009;11(1):58‐66. [MEDLINE: 19281446]CENTRAL
Gallagher M, Bellomo R, Cass A, Finfer S, Gattas D, Lee J, et al. Long term outcomes of severe AKI: results of the post‐RENAL study [abstract no: 071]. Nephrology 2012;17(Suppl 2):45‐6. [EMBASE: 71377309]CENTRAL
Gallagher M, Cass A, Bellomo R, Finfer S, Gattas D, Lee J, et al. Long‐term survival and dialysis dependency following acute kidney injury in intensive care: extended follow‐up of a randomized controlled trial. PLoS Medicine 2014;11(2):e1001601. [MEDLINE: 24523666]CENTRAL
Jun M, Bellomo R, Cass A, Gallagher M, Lo S. Timing of renal replacement therapy and patient outcomes in the randomized evaluation of normal vs augmented level of replacement therapy trial [abstract no: 008]. Nephrology 2012;17(Suppl 2):29‐30. [EMBASE: 71377246]CENTRAL
RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, et al. An observational study fluid balance and patient outcomes in the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy trial. Critical Care Medicine 2012;40(6):1753‐60. [MEDLINE: 22610181]CENTRAL
RENAL Replacement Therapy Trial Investigators, Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, et al. Intensity of continuous renal‐replacement therapy in critically ill patients. New England Journal of Medicine 2009;361(17):1627‐38. [MEDLINE: 19846848]CENTRAL
RENAL Replacement Therapy Trial Investigators, Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, et al. Screening and study enrolment in the Randomized Evaluation of Normal vs. Augmented Level (RENAL) Replacement Therapy Trial. Blood Purification 2009;27(2):199‐205. [MEDLINE: 19256108]CENTRAL
RENAL Study Investigators, Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, et al. Design and challenges of the Randomized Evaluation of Normal versus Augmented Level Replacement Therapy (RENAL) Trial: high‐dose versus standard‐dose hemofiltration in acute renal failure. Blood Purification 2008;26(5):407‐16. [MEDLINE: 18856012]CENTRAL
Roberts D, Roberts M, Liu X, Roberts J, Lipman J, Bellomo R. Clearance of antibiotics by high and low intensity continuous renal replacement therapy in critically ill patients [abstract no: 232]. Nephrology 2010;15(Suppl 4):87. [EMBASE: 70467236]CENTRAL
Roberts DM, Liu X, Roberts JA, Nair P, Cole L, Roberts MS, et al. A multicenter study on the effect of continuous hemodiafiltration intensity on antibiotic pharmacokinetics. Critical Care (London, England) 2015;19(1):84. [MEDLINE: 25881576]CENTRAL
Wang AY, Bellomo R, Ninomiya T, Lo S, Cass A, Jardine M, et al. Angiotensin‐converting enzyme inhibitor usage and acute kidney injury: a secondary analysis of RENAL study outcomes. Nephrology 2014;19(10):617‐22. [MEDLINE: 24894685]CENTRAL

Ronco 2000a {published data only}

Ho TB, Jefferson HJ, Rhodes A. Continuous haemofiltration in acute renal failure. Lancet 2000;356(9239):1441‐2. [MEDLINE: 11052612]CENTRAL
Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, et al. Effects of different doses in continuous veno‐venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet 2000;356(9223):26‐30. [MEDLINE: 10892761]CENTRAL
Ronco C, Belomo R, Homel P, Brendolan A, Dan M, Piccinni P, et al. Effects of different doses in continuous veno‐venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Edtna‐Erca Journal 2002;Suppl 2:7‐12. [MEDLINE: 12371727]CENTRAL
Ronco C, Homel P, Bellomo R, Brendolan A. Prospective randomised trial on dose delivery versus outcomes of RF treated by continuous veno‐venous hemofiltration (CVVH) [abstract no: A0717]. Journal of the American Society of Nephrology 2000;11(Sept):133A. [CENTRAL: CN‐00644229]CENTRAL
Schiffl H. Continuous haemofiltration in acute renal failure. Lancet 2000;356(9239):1441. [MEDLINE: 11052611]CENTRAL
Than N, Turney JH. Continuous haemofiltration in acute renal failure. Lancet 2000;356(9239):1441. [MEDLINE: 11052610]CENTRAL

Saudan 2006 {published data only}

Saudan P, Niederberger M, De Seigneux S, Romand J, Pugin J, Perneger T, et al. A prospective randomized trial comparing continuous hemodiafiltration versus hemofiltration in critically ill patients with acute renal failure [abstract no: PUB003]. Journal of the American Society of Nephrology 2004;15(Oct):763A. [CENTRAL: CN‐00724917]CENTRAL
Saudan P, Niederberger M, De Seigneux S, Romand J, Pugin J, Perneger T, et al. Adding a dialysis dose to continuous hemofiltration increases survival in patients with acute renal failure. Kidney International 2006;70(7):1312‐7. [MEDLINE: 16850022]CENTRAL
Saudan P, Niederberger M, Sellweger M, Pugin J, Romand J, Perneger T, et al. Continuous hemofiltration versus continuous hemodiafiltration in critically ill patients with acute renal failure [abstract no: PUB003]. Nephrology Dialysis Transplantation 2003;18(Suppl 4):666. [CENTRAL: CN‐00447595]CENTRAL
Saudan P, Triverio PA, Romand JA, Pugin J, Martin PY. Long‐term prognosis in critically ill patients with acute renal failure treated by continuous renal replacement therapy [abstract no: TH‐PO822]. Journal of the American Society of Nephrology 2006;17(Abstracts):282A. [CENTRAL: CN‐00724918]CENTRAL
Triverio PA, Martin PY, Romand J, Pugin J, Perneger T, Saudan P. Long‐term prognosis after acute kidney injury requiring renal replacement therapy. Nephrology Dialysis Transplantation 2009;24(7):2186‐9. [MEDLINE: 19228754]CENTRAL

Tolwani 2008 {published data only}

Lyndon W, Wille K, Tolwani A. Solute clearance in CRRT: comparing measured effluent volume to actual delivered dose [abstract no: 177]. American Journal of Kidney Diseases 2011;57(4):A61. [CENTRAL: 70379736]CENTRAL
Lyndon WD, Wille KM, Tolwani AJ. Solute clearance in CRRT: comparing measured effluent volume to actual delivered dose [abstract no: 26]. 16th International Conference on CRRT; 2011 Feb 22‐25; San Diego, CA. 2011:127. CENTRAL
Lyndon WD, Wille KM, Tolwani AJ. Solute clearance in CRRT: prescribed dose versus actual delivered dose. Nephrology Dialysis Transplantation 2012;27(3):952‐6. [MEDLINE: 21896498]CENTRAL
Tolwani AJ, Campbell RC, Stofan BS, Lai KR, Oster RA, Wille KM. Standard versus high‐dose CVVHDF for ICU‐related acute renal failure. Journal of the American Society of Nephrology 2008;19(6):1233‐8. [MEDLINE: 18337480]CENTRAL
Tolwani AJ, Speer R, Stofan B, Lai KR, Wille KM. A randomized prospective study comparing high dose continuous venovenous hemodiafiltration (CVVHDF) to standard CVVHDF in critically ill patients with acute renal injury [abstract no: 22]. Blood Purification 2007;25:193. CENTRAL

References to studies excluded from this review

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Boussekey 2008 {published data only}

Boussekey N, Chiche A, Faure K, Devos P, Guery B, d'Escrivan T, et al. A pilot randomized study comparing high and low volume hemofiltration on vasopressor use in septic shock. Intensive Care Medicine 2008;34(9):1646‐53. [MEDLINE: 18542921]CENTRAL

Brause 2003 {published data only}

Brause M, Neumann A, Schumacher T, Grabensee B, Heering P. Effect of filtration volume of continuous venovenous hemofiltration in the treatment of patients with acute renal failure in intensive care units. Critical Care Medicine 2003;31(3):841‐6. [MEDLINE: 12626994]CENTRAL

Cole 2002 {published data only}

Cole L, Bellomo R, Hart G, Journois D, Davenport P, Tipping P, et al. A phase II randomized, controlled trial of continuous hemofiltration in sepsis. Critical Care Medicine 2002;30(1):100‐6. [MEDLINE: 11902250]CENTRAL

Ghani 2006 {published data only}

Ghani RA, Zainudin S, Ctkong N, Rahman AF, Wafa SR, Mohamad M, et al. Serum IL‐6 and IL‐1‐ra with sequential organ failure assessment scores in septic patients receiving high‐volume haemofiltration and continuous venovenous haemofiltration. Nephrology 2006;11(5):386‐93. [MEDLINE: 17014550]CENTRAL
Zainudin S, Ghani RA, Mohd M, Wafa SR, Tong NK. Stability of haemodynamic parameters during CRRT: a comparison between standard continuous venovenous haemofiltration and high‐volume haemofiltration in patients with acute renal failure and sepsis [abstract no: SP286]. Nephrology Dialysis Transplantation 2006;21(Suppl 4):iv108. [CENTRAL: CN‐00583762]CENTRAL

HEROICS Study 2015 {published data only}

Combes A, Brechot N, Amour J, Cozic N, Lebreton G, Guidon C, et al. Early High‐Volume Hemofiltration versus Standard Care for Post‐Cardiac Surgery Shock. The HEROICS Study. American Journal of Respiratory & Critical Care Medicine 2015;192(10):1179‐90. [MEDLINE: 26167637]CENTRAL

IVOIRE Study 2013 {published data only}

Joannes‐Boyau O, Honore PM, Perez P, Bagshaw SM, Grand H, Canivet JL, et al. High‐volume versus standard‐volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial. Intensive Care Medicine 2013;39(9):1535‐46. [MEDLINE: 23740278]CENTRAL

Jiang 2005 {published data only}

Jiang HL, Xue WJ, Li DQ, Yin AP, Xin X, Li CH, et al. Influence of continuous veno‐venous hemofiltration on the course of acute pancreatitis. World Journal of Gastroenterology 2005;11(31):4815‐21. [MEDLINE: 16097050]CENTRAL

NCT01191905 {published data only}

Kim DK, Yoo TH. Effects of high volume continuous renal replacement therapy in patients with septic acute kidney injury. www.clinicaltrials.gov/ct2/show/NCT01191905 (accessed 25 August 2016). CENTRAL

NCT01251081 {published data only}

Chen J. Effect of the intensity of continuous renal replacement therapy in patients with sepsis and acute kidney injury: single‐center randomized clinical trial. www.clinicaltrials.gov/ct2/show/NCT01251081 (accessed 25 August 2016). CENTRAL

Payen 2009 {published data only}

Payen D, Mateo J, Cavaillon JM, Fraisse F, Floriot C, Vicaut E, et al. Impact of continuous venovenous hemofiltration on organ failure during the early phase of severe sepsis: a randomized controlled trial. Critical Care Medicine 2009;37(3):803‐10. [MEDLINE: 19237881]CENTRAL

Sanchez 2010b {published data only}

Sanchez C, Corbalan P, Rodriguez F, Sanchez A, Palominos S. Intensive high volume hemofiltration vs very high volume hemofiltration: effects on hemodynamics in patients with severe sepsis: a nursing approach [abstract no: 0432]. Intensive Care Medicine 2010;36(2 Suppl 2):S193. CENTRAL

Vesconi 2009 {published data only}

Vesconi S, Cruz DN, Fumagalli R, Kindgen‐Milles D, Monti G, Marinho A, et al. Delivered dose of renal replacement therapy and mortality in critically ill patients with acute kidney injury. Critical Care (London, England) 2009;13(2):1‐14. [MEDLINE: 19368724]CENTRAL

Zha 2012 {published data only}

Zha Y, Yang X, Lin X, Yuan J, Hu Y, Long YJ, et al. Clinical observation of different doses of continuous renal replacement therapy for severe pneumonia with acute kidney injury. Chung‐Hua i Hsueh Tsa Chih [Chinese Medical Journal] 2012;92(48):3385‐8. [MEDLINE: 23327695]CENTRAL

Zhang 2012 {published data only}

Zhang P, Yang Y, Lv R, Zhang Y, Xie W, Chen J. Effect of the intensity of continuous renal replacement therapy in patients with sepsis and acute kidney injury: a single‐centre randomized clinical trial. Nephrology Dialysis Transplantation 2012;27(3):967‐73. [MEDLINE: 21891773]CENTRAL

References to studies awaiting assessment

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NCT01560650 {published data only}

Shi W. Effect of the intensity of continuous renal replacement therapy in patients with acute kidney injury: single‐centre randomised clinical trial. www.clinicaltrials.gov/ct2/show/NCT01560650 (accessed 25 August 2016). CENTRAL

Bagshaw 2007

Bagshaw SM, George C, Bellomo R, ANZICS Database Management Committee. Changes in the incidence and outcome for early acute kidney injury in a cohort of Australian intensive care units. Critical Care (London, England) 2007;11(3):R68. [MEDLINE: 17588270]

Bellomo 2013

Bellomo R, Lipcsey M, Calzavacca P, Haase M, Haase‐Fielitz A, Licari E, et al. Early acid‐base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis. Intensive Care Medicine 2013;39(3):429‐36. [MEDLINE: 23306586]

Bihorac 2005

Bihorac A, Ross EA. Continuous venovenous hemofiltration with citrate‐based replacement fluid: efficacy, safety, and impact on nutrition. American Journal of Kidney Diseases 2005;46(5):908‐18. [MEDLINE: 16253732]

Borthwick 2013

Borthwick EM, Hill CJ, Rabindranath KS, Maxwell AP, McAuley DF, Blackwood B. High‐volume haemofiltration for sepsis. Cochrane Database of Systematic Reviews 2013, Issue 1. [DOI: 10.1002/14651858.CD008075.pub2]

Bouchard 2009

Bouchard J, Soroko SB, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney International 2009;76(4):422–7. [MEDLINE: 19436332]

Brunnet 1999

Brunnet S, Leblanc M, Geadah D, Parent D, Courteau S, Cardinal J. Diffusive and convective solute clearances during continuous renal replacement therapy at various dialysate and ultrafiltration flow rates. American Journal of Kidney Diseases 1999;34(3):486–92. [MEDLINE: 10469859]

Clark 1999

Clark WR, Ronco C. CRRT efficiency and efficacy in relation to solute size. Kidney International ‐ Supplement 1999;56(72):S3‐7. [MEDLINE: 10560796]

Clark 2014

Clark E, Molnar AO, Joannes‐Boyau O, Honoré PM, Sikora L, Bagshaw SM. High‐volume hemofiltration for septic acute kidney injury: a systematic review and meta‐analysis. Critical Care (London, England) 2014;18(1):R7. [MEDLINE: 24398168]

Claure‐Del Granado 2011

Claure‐Del Granado R, Macedo E, Chertow GM, Soroko S, Himmelfarb J, Ikizler TA, et al. Effluent volume in continuous renal replacement therapy overestimates the delivered dose of dialysis.[Erratum appears in Clin J Am Soc Nephrol. 2011 Jul;6(7):1802]. Clinical Journal of The American Society of Nephrology: CJASN 2011;6(3):467–75. [MEDLINE: 21115626]

Claure‐Del Granado 2012

Claure‐Del Granado R, Macedo E, Chertow GM, Soroko S, Himmelfarb J, Ikizler TA, et al. Toward the optimal dose metric in continuous renal replacement therapy. International Journal of Artificial Organs 2012;35(6):413‐24. [MEDLINE: 22466995]

Davenport 2010

Davenport A, Farrington K. Dialysis dose in acute kidney injury and chronic dialysis. Lancet 2010;375(9716):705‐6. [MEDLINE: 20167358]

Fayad 2013a

Fayad AI, Buamscha DG, Ciapponi A. Timing of continuous renal replacement therapy initiation for acute kidney injury. Cochrane Database of Systematic Reviews 2013, Issue 6. [DOI: 10.1002/14651858.CD010612]

Foland 2004

Foland JA, Fortenberry JD, Warshaw BL, Pettignano R, Merritt RK, Heard ML, et al. Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis. Critical Care Medicine 2004;32(8):1771–6. [MEDLINE: 15286557]

Gibney 2008

Gibney N, Cerda J, Davenport A, Ramirez J, Singbartl K, Leblanc M, et al. Volume management by renal replacement therapy in acute kidney injury. International Journal of Artificial Organs 2008;31(2):145‐55. [MEDLINE: 18311730]

Goldstein 2001

Goldstein S, Currier H, Graf JM, Cosio CC, Brewer ED, Sachdeva R. Outcome in children receiving continuous venovenous hemofiltration. Pediatrics 2001;107(6):1309‐12. [MEDLINE: 11389248]

GRADE 2008

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck‐Ytter Y, Alonso‐Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924‐6. [MEDLINE: 18436948]

Grootendorst 1992

Grootendorst AF, van Bommel EF, van der Hoven B, van Leengoed LA, van Osta AL. High volume hemofiltration improves right ventricular function in endotoxin‐induced shock in the pig. Intensive Care Medicine 1992;18(4):235‐40. [MEDLINE: 1430589]

Higgins 2003

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. [MEDLINE: 12958120]

Higgins 2011

Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Honore 2000

Honore PM, Jamez J, Wauthier M, Lee PA, Dugernier T, Pirenne B, et al. Prospective evaluation of short‐term, high‐volume isovolemic hemofiltration on the hemodynamic course and outcome in patients with intractable circulatory failure resulting from septic shock. Critical Care Medicine 2000;28(11):3581–7. [MEDLINE: 11098957]

Hoste 2006

Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Critical Care (London, England) 2006;10(3):R73. [MEDLINE: 16696865]

Joannidis 2005

Joannidis M, Metnitz PG. Epidemiology and natural history of acute renal failure in the ICU. Critical Care Clinics 2005;21(2):239–49. [MEDLINE: 15781160]

Jun 2010

Jun M, Hiddo J, Heerspink L, Ninomiya T, Gallagher M, Bellomo R, et al. Intensities of renal replacement therapy in acute kidney injury: a systematic review and meta‐analysis. Clinical Journal of The American Society of Nephrology: CJASN 2010;5(6):956–63. [MEDLINE: 20395356]

KDIGO 2012

KDIGO. Dialysis interventions for treatment of AKI. Kidney International ‐ Supplement 2012;2:89‐115. [DOI: 10.1038/kisup.2011.35]

Lehner 2014

Lehner GF, Wiedermann CJ, Joannidis M. High‐volume hemofiltration in critically ill patients: a systematic review and meta‐analysis. Minerva Anestesiologica 2014;80(5):595‐609. [MEDLINE: 24292260]

Liao 2003

Liao Z, Zhang W, Hardy PA, Poh CK, Huang Z, Kraus MA, et al. Kinetic comparison of different acute dialysis therapies. Artificial Organs 2003;27(9):802–7. [MEDLINE: 12940902]

Lowrie 1981

Lowrie EG, Laird NM, Parker TF, Sargent JA. Effect of the hemodialysis prescription of patient morbidity: report from the National Cooperative Dialysis Study. New England Journal of Medicine 1981;305(20):1176–81. [MEDLINE: 7027040]

Lyndon 2012

Lyndon WD, Wille KM, Tolwani AJ. Solute clearance in CRRT: prescribed dose versus actual delivered dose. Nephrology Dialysis Transplantation 2012;27(3):952–6. [MEDLINE: 21896498]

Marshall 2006

Marshall MR. Current status of dosing and quantification of acute renal replacement therapy. Part 2: dosing paradigms and clinical implementation. Nephrology 2006;11(3):181‐91. [MEDLINE: 16756629]

Mehta 1999

Mehta RL, Letteri JM. Current status of renal replacement therapy for acute renal failure. A survey of US nephrologists. The National Kidney Foundation Council on Dialysis. American Journal of Nephrology 1999;19(3):377–82. [MEDLINE: 10393374]

Mehta 2007

Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Critical Care (London, England) 2007;1(2):R31. [MEDLINE: 17331245]

Metnitz 2002

Metnitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, et al. Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Critical Care Medicine 2002;30(9):2051–8. [MEDLINE: 12352040]

Morimatsu 2003

Morimatsu H,  Uchino S, Bellomo R,  Ronco C. Continuous renal replacement therapy: does technique influence electrolyte and bicarbonate control?. International Journal of Artificial Organs 2003;26(4):289‐96. [MEDLINE: 12757027]

Negash 2011

Negash DT, Dhingra VK, Copland M, Griesdale D, Henderson W. Intensity of continuous renal replacement therapy in acute kidney injury in the intensive care unit: a systematic review and meta‐analysis. Vascular & Endovascular Surgery 2011;45(6):504‐10. [MEDLINE: 21646231]

Paganini 1996

Paganini EP, Sandy D, Moreno L, Kozlowski L, Sakai K. The effect of sodium and ultrafiltration modelling on plasma volume changes and haemodynamic stability in intensive care patients receiving haemodialysis for acute renal failure: a prospective, stratified, randomized, cross‐over study. Nephrology Dialysis Transplantation 1996;11 Suppl 8:32‐7. [MEDLINE: 9044338]

Palevsky 2002

Palevsky PM, Bunchman T, Tetta C. The Acute Dialysis Quality Initiative‐‐part V: operational characteristics of CRRT. Advances in Renal Replacement Therapy 2002;9(4):268–72. [MEDLINE: 12382230]

Palevsky 2005

Palevsky PM, Baldwin I, Davenport A, Goldstein S, Paganini E. Renal replacement therapy and the kidney: minimizing the impact of renal replacement therapy on recovery of acute renal failure. Current Opinion in Critical Care 2005;11(6):548‐54. [MEDLINE: 16292058]

Palevsky 2009

Palevsky PM, O´Connor TZ, Chertow GM, Crowley ST, Zhang JH, Kellum JA, et al. Intensity of renal replacement therapy in acute kidney injury: perspective from within the acute Renal Failure Trial Network Study. Critical Care (London, England) 2009;13(4):310. [MEDLINE: 19678919]

Parker 1994

Parker TF, Husni L, Huang W, Lew N, Lowrie EG. Survival of hemodialysis patients in the United States is improved with a greater quantity of dialysis. American Journal of Kidney Diseases 1994;23(5):670–80. [MEDLINE: 8172209]

Phu 2002

Phu NH, Hien TT, Mai NT, Chau TT, Chuong LV, Loc PP, et al. Hemofiltration and peritoneal dialysis in infection‐associated acute renal failure in Vietnam. New England Journal of Medicine 2002;347(12):895–902. [MEDLINE: 12239258]

Ronco 2002

Ronco C, Brendolan A, Lonnemann G, Bellomo R, Piccinni P, Digito A, et al. A pilot study of coupled plasma filtration with adsorption in septic shock. Critical Care Medicine 2002;30(6):1250–5. [MEDLINE: 12072677]

Schneider 2010

Schneider J, Khemani R, Grushkin C, Bart R. Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Critical Care Medicine 2010;38(3):933–9. [MEDLINE: 20124891]

Schünemann 2011a

Schünemann HJ, Oxman AD, Higgins JP, Vist GE, Glasziou P, Guyatt GH. Chapter 11: Presenting results and 'Summary of findings' tables. In: Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Schünemann 2011b

Schünemann HJ, Oxman AD, Higgins JP, Deeks JJ, Glasziou P, Guyatt GH. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Sieberth 1995

Sieberth HG, Stummvoll HK, Kierdoff H (editors). Continuous extracorporeal treatment in multiple organ dysfunction syndrome: 3rd International Conference on Continuous Hemofiltration. Vienna, July 8, 1994 (Contributions to Nephrology). Vol. 116, Basal: Karger, 1995.

Sutherland 2010

Sutherland SM, Zappitelli M, Alexander SR, Chua AN, Brophy PD, Bunchman TE, et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. American Journal of Kidney Diseases 2010;55(2):316–25. [MEDLINE: 20042260]

Uchino 2001

Uchino S, Bellomo R, Ronco C. Intermittent versus continuous renal replacement therapy in the ICU: impact on electrolyte and acid‐base balance. Intensive Care Medicine 2001;27(6):1031‐47. [MEDLINE: 11497136]

Uchino 2005

Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005;294(7):813‐8. [MEDLINE: 16106006]

Van Wert 2010

Van Wert R, Friedrich JO, Scales DC, Wald R, Adhikari NK, University of Toronto Acute Kidney Injury Research Group. High‐dose renal replacement therapy for acute kidney injury: systematic review and meta‐analysis. Critical Care Medicine 2010;38(5):1360‐9. [MEDLINE: 20308884]

References to other published versions of this review

Jump to:

Fayad 2013b

Fayad AI, Buamscha DG, Ciapponi A. Intensity of continuous renal replacement therapy for acute kidney injury. Cochrane Database of Systematic Reviews 2013, Issue 6. [DOI: 10.1002/14651858.CD010613]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Jump to:

ATN Study 2005

Methods

  • Study design: prospective, parallel RCT

  • Study duration: November 2003 to July 2007

Participants

  • Setting: multicentre (27 ICU)

  • Country: USA

  • Critically ill patients aged ≥ 18 years with AKI due to ATN who require RRT defined as a) Clinical setting of Ischaemic or nephrotoxic injury, b) oliguria (average urine output ≤ 20 mL/hour) for > 24 hours or an increase in SCr of ≥ 2mg/dL (177 μmol/L) in males or ≥ 1.5 mg/dL (133 μmol/L) in females over a period of ≤ 4 days; receiving care in a critical care unit); 1 non‐renal organ failure (SOFA score ≥ 2) or the presence of sepsis; patient/surrogate willing to provide informed consent

  • Number: treatment group (563); control group (561)

    • CRRT treatment: 783 patients (69.7%)

  • Mean age ± SD (years): treatment group (59.6 ±15.3); control group (59.7 ± 15.2)

  • Sex (M/F): treatment group (409/154); control group (384/176)

  • Exclusion criteria: baseline SCr > 2 mg/dL (177 μmol/L) in males, > 1.5 mg/dL (133 μmol/L) in females; AKI clinically believed to be due to an aetiology other than ATN; more than 72 hours since meeting both of the following conditions a) fulfilment of the definition of AKI, b) BUN > 100 mg/dL (36 mmol/L); ≥ 1 HD treatment or more than 24 hours since starting CRRT; prior kidney transplant; pregnancy; prisoner; weight > 128.5 kg; non‐candidacy for RRT; moribund state; patient not expected to survive 28 days because of underlying terminal chronic medical condition; comfort‐measures‐only status; participation in a concurrent interventional study; patient/surrogate refusal; physician refusal

Interventions

  • Modalities: IHD, CVVHDF, SLED

  • Haemofilter: cellulose triacetate or synthetic membranes

  • Replacement fluid: pre‐dilution mode

  • Anticoagulation: heparin, citrate, other

Treatment group

  • Intensive management strategy

    • If haemodynamically stable

      • IHD 6 times/week (target delivered Kt/V ˜ 1.2 to 1.4/treatment)

    • If haemodynamically unstable

      • CVVHDF at 35 mL/kg/h; or

      • SLED, 6 times/week (target delivered Kt/V ˜ 1.2 to 1.4/treatment)

Control group

  • Conventional management strategy

    • If haemodynamically stable

      • IHD 3 times/week (target delivered Kt/V ˜ 1.2 to 1.4/treatment)

    • If haemodynamically unstable

      • CVVHDF at 20 mL/kg/h; or

      • SLED, 3 times/week (target delivered Kt/V ˜ 1.2 to 1.4/treatment)

Co‐interventions

  • Not reported

Outcomes

Primary outcomes

  • Mortality from any cause at day 60

Secondary outcomes

  • Hospital mortality

  • 1 year mortality

  • Recovery of kidney function by day 28

Tertiary endpoints

  • Duration of RRT

  • ICU length of stay

  • Hospital length of stay

  • Discharge to “home” off of dialysis by day 60

  • SOFA scores at days 1 to 14, 21 and 28

Economic analysis

  • RRT‐specific cost of care

  • Global cost of care

  • Patient utility

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Patients randomly assigned to one of the two treatment groups by means of a centralized, computer‐generated method

Allocation concealment (selection bias)

Low risk

Central allocation process

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement (for kidney recovery was unclear risk but for mortality was low risk)

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

The outcome measurement is not likely to be influenced by lack of blinding

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Per cent followed: 99.55%

Selective reporting (reporting bias)

Low risk

The study reported mortality, kidney function recovery and adverse events

Other bias

Low risk

Funding sources were reported
Bouman 2002

Methods

  • Study design: parallel RCT

  • Study duration: May 1998 to March 2000

Participants

  • Setting: 2 centres

  • Country: The Netherlands

  • Patients with circulatory and respiratory insufficiency and early AKI who need CRRT; CrCl < 20 mL/min, and oliguria < 180 mL/6 h despite fluid resuscitation; circulatory support and furosemide; early timing: < 12 h inclusion; late timing: BUN > 40 mmol/L or severe pulmonary oedema

  • Number: treatment group 1 (35); treatment group 2 (35); control group (36)

  • Mean age ± SD (years): treatment group 1 (68 ± 13); treatment group 2 (70 ± 10); control group (67 ± 13)

  • Sex (M/F): treatment group 1 (21/14); treatment group 2 (20/15); control group (23/13)

  • Exclusion criteria: pre‐existing kidney disease with CrCl of 30 mL/min; AKI caused by permanent occlusion or surgical lesion of the renal artery; glomerulonephritis, interstitial nephritis, or vasculitis; postrenal obstruction; CHILD class C liver cirrhosis; AIDS with a CD4 count of 0.05 109/L; non‐witnessed arrest with Glasgow Coma Score 5; haematologic malignancy with neutrophil 0.05 x 109/L; no haemofiltration machine free for use at the moment of inclusion

Interventions

  • Modality: CVVH

  • Haemofilter: cellulose triacetate hollow‐fibre

  • Replacement fluid: post‐dilution mode with bicarbonate solution

  • Anticoagulation: heparin or nadroparin

Treatment group 1

  • Early + high volume haemofiltration group

    • Treatment started within 12 h after time of inclusion, and the ultrafiltration flow rate was high (prescribed dose > 72 L/d and delivered dose 48.2 mL/kg/h)

Treatment group 2

  • Early + low‐volume haemofiltration group

    • Treatment started within 12 h after time of inclusion, and the ultrafiltration flow rate was low (prescribed dose 24 to 36 L/d and delivered dose 19 to 20 mL/kg/h)

Control group

  • Late + low‐volume haemofiltration group

    • Treatment started when the patient fulfilled the conventional criteria for RRT: urea level 40 mmol/L, potassium 6.5 mmol/L or severe pulmonary oedema, and the ultrafiltration flow rate was low (24 to 36 L/d and delivered dose 19 to 20 mL/kg/h)

Co‐interventions

  • Not reported

Outcomes

Primary outcomes

  • Mortality at day 28

  • Recovery of kidney function

Secondary outcomes

  • ICU survival

  • Hospital survival

  • Duration of mechanical ventilation

  • Length of ICU stay

  • Length of hospitalisation

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Patients randomly assigned to the treatment dosage using computer‐generated method

Allocation concealment (selection bias)

Low risk

Treatment assignments were kept in numbered, sealed opaque envelopes that were opened at the time of enrolment

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement (for kidney recovery was unclear risk but for mortality was low risk)

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

The outcome measurement is not likely to be influenced by lack of blinding

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No incomplete data were reported

Selective reporting (reporting bias)

Low risk

The study reported mortality, kidney function recovery and adverse events

Other bias

Unclear risk

Insufficient information to permit judgement
RENAL Study 2006

Methods

  • Study design: prospective, parallel RCT

  • Study duration: December 2005 to November 2008

Participants

  • Setting: 35 ICU

  • Countries: Australia and New Zealand

  • Critically ill AKI patients who need CRRT; oliguria (urine output < 100 mL in 6 h period) unresponsive to fluid resuscitation measures; potassium > 6.5 mmol; severe acidaemia pH < 7.2/L; urea nitrogen level > 70 mg/dL or 25 mmol/L; SCr > 3.4 mg/dL or 300 μmol/L; pulmonary oedema

  • Number: treatment group (722); control group (743)

  • Mean age ± SD (years): treatment group (64.7 ± 14.5); control group (64.4 ± 15.3)

  • Sex (M/F): treatment group (474/248); control group (472/271)

  • Exclusion criteria: patients who had received any previous RRT during the same hospital admission or maintenance dialysis for study; patients with ESKD

Interventions

  • Modality: CVVHDF

  • Qb: 150 mL/min

  • Haemofilter: polyacrylonitrile hollow‐fibre

  • Replacement fluid: post‐dilution mode with bicarbonate solution

Treatment group

  • Higher intensity CRRT

    • Prescribed dose: 40 mL/kg/h of effluent dose (delivered dose 33.4 ± 12.8 mL/kg/h)

Control group

  • Lower intensity CRRT

    • Prescribed dose: 25 mL/kg/h of effluent dose (delivered dose 22 ± 17.8 mL/kg/h)

Co‐interventions

  • Not reported

Outcomes

Primary outcomes

  • Mortality at 90 days

Secondary outcomes

  • Mortality at 28 days; in the ICU; in the hospital

  • Numbers of days of RRT; in ICU; in hospital; of mechanical ventilation

  • Number of non‐renal organ failures

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Patients were randomly assigned using computer‐generated methodology

Allocation concealment (selection bias)

Low risk

Central allocation process

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

The outcome measurement was unlikely to be influenced by lack of blinding

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Complete follow up data

Selective reporting (reporting bias)

Low risk

The study reported mortality, kidney function recovery and adverse events

Other bias

Low risk

Funding sources were reported
Ronco 2000a

Methods

  • Study design: prospective, parallel RCT

  • Study duration: 1994 to September 1999

Participants

  • Setting: 2 different ICU in the same hospital

  • Country: Italy

  • Critically ill AKI patients who need CRRT; admission to ICU

  • Number: treatment group 1 (139); treatment group 2 (140); control group (146)

  • Mean age ± SD (years): treatment group 1 (59 ± 9); treatment group 2 (63 ± 12); control group (61 ± 10)

  • Sex (M/F): treatment group 1 (77/62); treatment group 2 (80/60); control group (81/65)

  • Exclusion criteria: not reported

Interventions

  • Modality: CVVH

  • Haemofilters: polysulfone hollow‐fibre

  • Qb: 120 and 240 mL/min

  • Anticoagulation: systemic heparin

  • Replacement fluid: post‐dilution mode with lactate solution

Treatment group 1

  • Higher intensity CRRT

    • Prescribed dose: 35 mL/kg/h (delivered dose 33.5 mL/kg/h)

Treatment group 2

  • Higher intensity CRRT

    • Prescribed dose: 45 mL/kg/h (delivered dose 42.5 mL/kg/h)

Control group

  • Lower intensity CRRT

    • Prescribed dose: 20 mL/kg/h (delivered dose 19 mL/kg/h)

Co‐interventions

  • Not reported

Outcomes

Primary outcome

  • Survival at day 15 after discontinuation of CVVH

Secondary outcomes

  • Recovery of kidney function 15 days after discontinuation of CVVH

  • Adverse events: clinical and technical complications

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Patients were randomly assigned using computer‐generated methodology

Allocation concealment (selection bias)

Low risk

Central allocation process

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Outcome measurement unlikely to be influenced by lack of blinding

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No losses to follow up

Selective reporting (reporting bias)

Low risk

Reported mortality, kidney function recovery and adverse events

Other bias

Unclear risk

Insufficient information to permit judgement
Saudan 2006

Methods

  • Study design: prospective, parallel RCT

  • Time frame: October 2000 to December 2003

Participants

  • Setting: medical and surgical ICU, University Hospital

  • Country: Switzerland

  • Critically ill patients with AKI who need CRRT; AKI cause was mostly medical

  • Number: treatment group (102); control group (104)

  • Mean age ± SD (years): treatment group (65 ± 12); control group (62 ± 15)

  • Sex (M/F): treatment group (65/37); control group (57/47)

  • Exclusion criteria: Pre‐renal failure; post‐renal failure; ESKD; patients on ACEi

Interventions

  • Modalities: CVVHDF and CVVH

  • Haemofilters: polyacrylonitrile hollow‐fibre

  • Qb: 100 to 125 mL/min

  • Replacement fluid: pre‐dilution mode with bicarbonate or lactate solution

  • Anticoagulation: heparin

Treatment group

  • Higher intensity CRRT

    • CVVHDF

      • Prescribed dose: 42 mL/kg/h

Control group

  • Lower intensity CRRT

    • CVVH

      • Prescribed dose: 25 mL/kg/h

Outcomes

Primary outcome

  • Survival at days 28 and 90

Secondary outcomes

  • Recovery of kidney function

  • Length of ICU stay

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Patients were randomly assigned using computer‐generated methodology in blocks of four and six patients

Allocation concealment (selection bias)

Unclear risk

Allocation was appropriate (sealed opaque envelopes). However, the table 1 showed a significant imbalance in the severity of illness observed between treatment arms

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Outcome measurement unlikely to be influenced by lack of blinding

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No dropouts or losses to follow up

Selective reporting (reporting bias)

Low risk

Reported mortality, kidney function recovery and adverse events

Other bias

Unclear risk

Insufficient information to permit judgement
Tolwani 2008

Methods

  • Study design: prospective, parallel RCT

  • Study duration: August 2003 to March 2006

Participants

  • Setting: University of Alabama (ICU)

  • Country: USA

  • ≥ 18 years; critically ill patients with AKI who need CRRT; AKI was mostly medical‐volume overload despite diuretics; oliguria (urine output < 200 mL/12 h) despite fluid resuscitation and diuretics; anuria (urine output < 50 mL/12 h); azotaemia (BUN ≥ 80 mg/dL); hyperkalaemia (K ≥ 6.5 mmol/L); SCr increase > 2.5 mg/dL from normal values or a sustained rise in SCr ≥ 1 mg/dL over baseline

  • Number: treatment group (100); control group (100)

  • Mean age ± SD (years): treatment group (56 ± 16); control group (62 ± 15)

  • Sex (M/F): treatment group (59/41); control group (57/43)

  • Relevant health status: critically ill patients with AKI who need CRRT

  • Exclusion criteria: previous IHD treatment; 24 h CRRT at time of enrolment; weighed > 125 or < 50 kg (limitations of machine); SKD

Interventions

  • Modality: CVVHDF

  • Haemofilters: polyacrylonitrile hollow‐fibre

  • Qb: 100 to 125 mL/min

  • Replacement fluid: pre‐dilution mode

  • Anticoagulation: heparin or no anticoagulation

Treatment group

  • Higher intensity CRRT

    • Prescribed dose: 35 mL/kg/h

Control group

  • Lower intensity CRRT

    • Prescribed dose: 25 mL/kg/h

Co‐interventions

  • Not reported

Outcomes

Primary outcome

  • Survival in ICU discharge or 30 day

Secondary outcomes

  • ICU survival

  • Hospital survival

  • ICU kidney recovery

  • Hospital kidney recovery

  • ICU length of stay

  • Hospital length of stay

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Patients were randomly assigned using computer‐generated methodology (1:1 ratio between treatment dosages)

Allocation concealment (selection bias)

Low risk

Treatment assignments were kept in numbered, sealed envelopes that were opened at the time of enrolment

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Outcome measurement unlikely to be influenced by lack of blinding

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Per cent followed: 100%

Selective reporting (reporting bias)

Low risk

Reported mortality, kidney function recovery and adverse events

Other bias

Low risk

Funding sources were reported

ACEi ‐ angiotensin‐converting enzyme inhibitors; AIDs ‐ acquired immune deficiency syndrome; AKI ‐ acute kidney injury; ATN ‐ acute tubular necrosis; BUN ‐ blood urea nitrogen; CrCl ‐ creatinine clearance; CRRT ‐ continuous renal replacement therapy; CVVH ‐ continuous venovenous haemofiltration; CVVHDF ‐ continuous venovenous haemodiafiltration; HD ‐ haemodialysis; ICU ‐ intensive care unit/s; IHD ‐ intermittent haemodialysis; M/F ‐ male/female; Qb ‐ extracorporeal blood flow; RCT ‐ randomised controlled trial; RRT ‐ renal replacement therapy; SCr ‐ serum creatinine; SD ‐ standard deviation; SLED ‐ sustained low‐efficiency dialysis; SOFA ‐ Sequential Organ Failure Assessment

Characteristics of excluded studies [ordered by study ID]

Jump to:

Study

Reason for exclusion

Boussekey 2008

Different intensity‐arms treatment; control arm was not within the pre‐specified range according to protocol: low volume HF (35 ml/kg/h) versus high volume HF (65 ml/kg/h); small sample size (< 20 participants)

Brause 2003

Not RCT

Cole 2002

Compared continuous dialysis therapy versus no haemofiltration

Ghani 2006

Outcomes not relevant for this review; intensity of CRRT was not assessed

HEROICS Study 2015

36% of patients in the control arm did not receive CRRT

IVOIRE Study 2013

Different intensity arms treatment; control arm is not within the pre‐specified range according to protocol: standard volume HF (35 mL/kg/h) versus high volume HF (70 mL/kg/h)

Jiang 2005

Different inclusion criteria; included patients with severe pancreatitis, but AKI was no obligatory condition for enrolment; AKI was observed in only 6 (16%) patients

NCT01191905

Different intensity arms treatment; less intensive arm is not within the pre‐specified range according to protocol: standard volume HF (40 mL/kg/h) versus high volume HF (80 mL/kg/h)

NCT01251081

Different intensity arms treatment; the control arm is not within the pre‐specified range according to protocol: high volume HF (50 mL/kg/h) versus extra high volume HF (85 mL/kg/h)

Payen 2009

Outcomes not relevant for this review; intensity of CRRT was not assessed

Sanchez 2010b

Different intensity arms treatment; control dose arms are not within the pre‐specified range according to protocol: high volume HF (35 mL/kg/h) versus very high volume HF (> 55 mL/kg/h)

Vesconi 2009

Compared CRRT versus IHD

Zha 2012

Not RCT

Zhang 2012

Different intensity arms treatment; the control arm is not within the pre‐specified range according to protocol: high volume HF (50 mL/kg/h) versus extra high volume HF (85 mL/Kg/h)

CRRT ‐ continuous renal replacement therapy; HF ‐ haemofiltration; IHD ‐ intermittent haemodialysis; RCT ‐ randomised controlled trial

Characteristics of studies awaiting assessment [ordered by study ID]

Jump to:

NCT01560650

Methods

  • Study design: RCT

  • Study duration: March 2011 to August 2015 (final data collection date for primary outcome measure)

Participants

  • Setting: Guangdong General Hospital

  • Country: China

  • CRRT indications for AKI (RIFLE criteria) patients with cardiac surgery

  • Number: 211

  • Age: ≥ 18 years

  • Exclusion criteria: < 18 years; CKD; dialysis history, to leave the ICU patients with AKI, CKD; all causes kidney damage (pathology, haematuria, and radiographic abnormalities) ≥ 3 months or GFR < 60 mL/min for 3 months or more

Interventions

Treatment group

  • High dose (35 mL/kg/h) CVVH

Control group

  • Low dose (25 mL/kg/h) CVVH

Outcomes

Primary outcomes

  • Death from any cause within 14, 28 and 90 days after randomisation

Secondary outcomes

  • Kidney outcome of survivors 14, 28 and 90 days after randomisation

Notes

  • This study is now completed; no study results have been posted (September 2016)

AKI ‐ acute kidney injury; CKD ‐ chronic kidney disease; CRRT ‐ continuous renal replacement therapy; CVVH ‐ continuous venovenous haemofiltration; GFR ‐ glomerular filtration rate; ICU ‐ intensive care unit/s; RCT ‐ randomised controlled trial

Data and analyses

Open in table viewer
Comparison 1. Intensive versus less intensive CRRT

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only
Analysis 1.1
Comparison 1 Intensive versus less intensive CRRT, Outcome 1 Mortality.

Comparison 1 Intensive versus less intensive CRRT, Outcome 1 Mortality.

1.1 Mortality at day 30

5

2402

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.71, 1.08]

1.2 Mortality after 30 days post‐randomisation

5

2759

Risk Ratio (M‐H, Random, 95% CI)

0.92 [0.80, 1.06]

2 Mortality in prespecified groups Show forest plot

5

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only
Analysis 1.2
Comparison 1 Intensive versus less intensive CRRT, Outcome 2 Mortality in prespecified groups.

Comparison 1 Intensive versus less intensive CRRT, Outcome 2 Mortality in prespecified groups.

2.1 Patients with sepsis

5

966

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.69, 1.27]

2.2 Patients without sepsis

4

1216

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.69, 1.15]

2.3 Patients with SOFA cardiovascular score < 3

1

404

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.71, 1.18]

2.4 Patients with SOFA cardiovascular ≥ 3

1

1056

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.92, 1.18]

2.5 Patients with AKI related to surgical causes

2

531

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.61, 0.88]

2.6 Patients with AKI unrelated to surgical causes

3

1871

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.73, 1.20]

3 Recovery of kidney function Show forest plot

5

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only
Analysis 1.3
Comparison 1 Intensive versus less intensive CRRT, Outcome 3 Recovery of kidney function.

Comparison 1 Intensive versus less intensive CRRT, Outcome 3 Recovery of kidney function.

3.1 Free of RRT after discontinuing CRRT

5

2402

Risk Ratio (M‐H, Random, 95% CI)

1.12 [0.91, 1.37]

3.2 Free of RRT after discontinuing CRRT at day 30

5

1416

Risk Ratio (M‐H, Random, 95% CI)

1.03 [0.96, 1.11]

3.3 Free of RRT after discontinuing CRRT at day 90

3

988

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.94, 1.01]

4 Kidney function recovery in prespecified subgroup Show forest plot

5

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only
Analysis 1.4
Comparison 1 Intensive versus less intensive CRRT, Outcome 4 Kidney function recovery in prespecified subgroup.

Comparison 1 Intensive versus less intensive CRRT, Outcome 4 Kidney function recovery in prespecified subgroup.

4.1 Patients with AKI related to surgical causes

2

531

Risk Ratio (M‐H, Random, 95% CI)

1.27 [1.05, 1.53]

4.2 Patients with AKI related to non‐surgical causes

3

1870

Risk Ratio (M‐H, Random, 95% CI)

1.12 [0.73, 1.71]

5 Length of stay Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only
Analysis 1.5
Comparison 1 Intensive versus less intensive CRRT, Outcome 5 Length of stay.

Comparison 1 Intensive versus less intensive CRRT, Outcome 5 Length of stay.

5.1 Days in hospital

2

1665

Mean Difference (IV, Random, 95% CI)

‐0.23 [‐3.35, 2.89]

5.2 Days in ICU

2

1665

Mean Difference (IV, Random, 95% CI)

‐0.58 [‐3.73, 2.56]

6 Metabolic control Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Analysis 1.6
Comparison 1 Intensive versus less intensive CRRT, Outcome 6 Metabolic control.

Comparison 1 Intensive versus less intensive CRRT, Outcome 6 Metabolic control.

6.1 Normalised metabolic acidosis

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 Adverse events Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only
Analysis 1.7
Comparison 1 Intensive versus less intensive CRRT, Outcome 7 Adverse events.

Comparison 1 Intensive versus less intensive CRRT, Outcome 7 Adverse events.

7.1 Patients experiencing adverse events

3

1753

Risk Ratio (M‐H, Random, 95% CI)

1.08 [0.73, 1.61]

7.2 Hypophosphataemia

1

1441

Risk Ratio (M‐H, Random, 95% CI)

1.21 [1.11, 1.31]

7.3 Hypokalaemia

1

1455

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.80, 1.15]

7.4 Arrhythmia

1

1463

Risk Ratio (M‐H, Random, 95% CI)

0.92 [0.80, 1.06]

7.5 Bleeding

3

1775

Risk Ratio (M‐H, Random, 95% CI)

0.78 [0.27, 2.24]

Study flow diagram
Figures and Tables -
Figure 1

Study flow diagram

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study
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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

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Funnel plot of comparison: 1 High Intensity versus less intensive CRRT, outcome: 1.1 Mortality
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Figure 4

Funnel plot of comparison: 1 High Intensity versus less intensive CRRT, outcome: 1.1 Mortality

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Comparison 1 Intensive versus less intensive CRRT, Outcome 1 Mortality.
Figures and Tables -
Analysis 1.1

Comparison 1 Intensive versus less intensive CRRT, Outcome 1 Mortality.

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Comparison 1 Intensive versus less intensive CRRT, Outcome 2 Mortality in prespecified groups.
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Analysis 1.2

Comparison 1 Intensive versus less intensive CRRT, Outcome 2 Mortality in prespecified groups.

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Comparison 1 Intensive versus less intensive CRRT, Outcome 3 Recovery of kidney function.
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Analysis 1.3

Comparison 1 Intensive versus less intensive CRRT, Outcome 3 Recovery of kidney function.

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Comparison 1 Intensive versus less intensive CRRT, Outcome 4 Kidney function recovery in prespecified subgroup.
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Analysis 1.4

Comparison 1 Intensive versus less intensive CRRT, Outcome 4 Kidney function recovery in prespecified subgroup.

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Comparison 1 Intensive versus less intensive CRRT, Outcome 5 Length of stay.
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Analysis 1.5

Comparison 1 Intensive versus less intensive CRRT, Outcome 5 Length of stay.

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Comparison 1 Intensive versus less intensive CRRT, Outcome 6 Metabolic control.
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Analysis 1.6

Comparison 1 Intensive versus less intensive CRRT, Outcome 6 Metabolic control.

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Comparison 1 Intensive versus less intensive CRRT, Outcome 7 Adverse events.
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Analysis 1.7

Comparison 1 Intensive versus less intensive CRRT, Outcome 7 Adverse events.

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Summary of findings for the main comparison. Intensive versus less intensive continuous renal replacement therapy (CRRT) for acute kidney injury (AKI)

Intensive versus less intensive CRRT for AKI

Patient or population: patients with AKI
Settings: ICU
Intervention: Intensive versus less intensive CRRT

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Less intensive CRRT

Intensive CRRT

Mortality at day 30
Follow‐up: 30 days

Study population

RR 0.88
(0.81 to 1.1)

2402 (5)

⊕⊕⊝⊝
low1,2

430 per 1000

420 per 1000
(412 to 523)

Moderate

Mortality after 30 days post‐randomisation
Follow‐up: 60 days

Study population

RR 0.92
(0.80 to 1.06)

2759 (5)

⊕⊕⊝⊝
low1,2

514 per 1000

483 per 1000
(416 to 565)

Moderate

593 per 1000

557 per 1000
(480 to 652)

Patients free of RRT after discontinuing CRRT
Follow‐up: 30 days

Study population

RR 1.12
(0.91 to 1.37)

2402 (5)

⊕⊕⊝⊝
low1,2

483 per 1000

541 per 1000
(439 to 661)

Moderate

390 per 1000

437 per 1000
(355 to 534)

Patients free of RRT after discontinuing CRRT
Follow‐up: 90 days

Study population

RR 0.98
(0.94 to 1.01)

988 (3)

⊕⊕⊕⊝
moderate3

923 per 1000

904 per 1000
(867 to 932)

Moderate

800 per 1000

784 per 1000
(752 to 808)

Adverse events: hypophosphataemia

Study population

RR 1.21
(1.11 to 1.31)

1441 (1)

⊕⊕⊕⊕
high

540 per 1000

654 per 1000
(600 to 708)

Moderate

540 per 1000

653 per 1000
(599 to 707)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval/s; RR: Risk ratio; RRT: renal replacement therapy

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

¹ inconsistency: due to substantial heterogeneity (I2 values ranged from 73% to 78%)

² imprecision: due to wide CI which crossed the threshold for clinically meaningful effects

³ Indirectness: critically ill patients with AKI in CRRT have high short‐term mortality risk; mortality is a competing end point for kidney recovery at day 90

Figures and Tables -
Summary of findings for the main comparison. Intensive versus less intensive continuous renal replacement therapy (CRRT) for acute kidney injury (AKI)
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Summary of findings 2. Intensive versus less intensive continuous renal replacement therapy (CRRT) for acute kidney injury (AKI): subgroups

Intensive versus less intensive CRRT for AKI: subgroups

Patient or population: patients with AKI who need CRRT
Settings: ICU
Intervention: Intensive CRRT
Comparison: Less intensive CRRT

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Standard dose

High dose

Mortality: patients with sepsis
Follow‐up: mean 28 days

Study population

RR 0.94
(0.69 to 1.27)

966 (5)

⊕⊕⊝⊝
low1,2

524 per 1000

492 per 1000
(361 to 665)

Moderate

618 per 1000

581 per 1000
(426 to 785)

Mortality: patients without sepsis
Follow‐up: mean 28 days

Study population

RR 0.89
(0.69 to 1.15)

1216 (4)

⊕⊕⊝⊝
low1,2

465 per 1000

414 per 1000
(321 to 535)

Moderate

564 per 1000

502 per 1000
(389 to 649)

Mortality: patients with AKI related to cardiac or general surgery
Follow‐up: mean 21 days

Study population

RR 0.73
(0.61 to 0.88)

531 (2)

⊕⊕⊕⊕
high

505 per 1000

368 per 1000
(308 to 444)

Moderate

459 per 1000

335 per 1000
(280 to 404)

Mortality: patients with AKI not related to surgery
Follow‐up: mean 30 days

Study population

RR 0.94
(0.73 to 1.20)

1871 (3)

⊕⊕⊝⊝
low1,2

414 per 1000

389 per 1000
(302 to 497)

Moderate

550 per 1000

517 per 1000
(402 to 660)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval/s; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

¹ inconsistency: due to substantial heterogeneity (I2 values ranged from 73% to 78%)

² imprecision: due to wide CI which crossed the threshold for clinically meaningful effects

Figures and Tables -
Summary of findings 2. Intensive versus less intensive continuous renal replacement therapy (CRRT) for acute kidney injury (AKI): subgroups
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Comparison 1. Intensive versus less intensive CRRT

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Mortality at day 30

5

2402

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.71, 1.08]

1.2 Mortality after 30 days post‐randomisation

5

2759

Risk Ratio (M‐H, Random, 95% CI)

0.92 [0.80, 1.06]

2 Mortality in prespecified groups Show forest plot

5

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Patients with sepsis

5

966

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.69, 1.27]

2.2 Patients without sepsis

4

1216

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.69, 1.15]

2.3 Patients with SOFA cardiovascular score < 3

1

404

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.71, 1.18]

2.4 Patients with SOFA cardiovascular ≥ 3

1

1056

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.92, 1.18]

2.5 Patients with AKI related to surgical causes

2

531

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.61, 0.88]

2.6 Patients with AKI unrelated to surgical causes

3

1871

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.73, 1.20]

3 Recovery of kidney function Show forest plot

5

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Free of RRT after discontinuing CRRT

5

2402

Risk Ratio (M‐H, Random, 95% CI)

1.12 [0.91, 1.37]

3.2 Free of RRT after discontinuing CRRT at day 30

5

1416

Risk Ratio (M‐H, Random, 95% CI)

1.03 [0.96, 1.11]

3.3 Free of RRT after discontinuing CRRT at day 90

3

988

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.94, 1.01]

4 Kidney function recovery in prespecified subgroup Show forest plot

5

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 Patients with AKI related to surgical causes

2

531

Risk Ratio (M‐H, Random, 95% CI)

1.27 [1.05, 1.53]

4.2 Patients with AKI related to non‐surgical causes

3

1870

Risk Ratio (M‐H, Random, 95% CI)

1.12 [0.73, 1.71]

5 Length of stay Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

5.1 Days in hospital

2

1665

Mean Difference (IV, Random, 95% CI)

‐0.23 [‐3.35, 2.89]

5.2 Days in ICU

2

1665

Mean Difference (IV, Random, 95% CI)

‐0.58 [‐3.73, 2.56]

6 Metabolic control Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

6.1 Normalised metabolic acidosis

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 Adverse events Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

7.1 Patients experiencing adverse events

3

1753

Risk Ratio (M‐H, Random, 95% CI)

1.08 [0.73, 1.61]

7.2 Hypophosphataemia

1

1441

Risk Ratio (M‐H, Random, 95% CI)

1.21 [1.11, 1.31]

7.3 Hypokalaemia

1

1455

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.80, 1.15]

7.4 Arrhythmia

1

1463

Risk Ratio (M‐H, Random, 95% CI)

0.92 [0.80, 1.06]

7.5 Bleeding

3

1775

Risk Ratio (M‐H, Random, 95% CI)

0.78 [0.27, 2.24]
Figures and Tables -
Comparison 1. Intensive versus less intensive CRRT
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