A prospective randomized comparative pilot trial on extended daily dialysis versus continuous venovenous hemodiafiltration in acute kidney injury after cardiac surgery

Badawy, S. H.; Hassan, Aly; Samir, Enas M.

doi:10.4103/1687-9090.124035

Cited by 20 publications

(23 citation statements)

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“…). Subgroup meta‐analysis for 30 day mortality also significantly favoured SLED (RR 1.36, 95% CI 1.06 to 1.75, I 2 = 0%, P = 0.02); however, subgroups based on location (hospital or ICU) revealed a non‐significant difference (hospital: RR 1.12, 95% CI 0.9 to 1.4, I 2 = 56%, P = 0.32; ICU: RR 1.44, 95% CI 0.93 to 2.24, I 2 = 56%, P = 0.1) (Fig. ; S6–S8).…”

Section: Resultsmentioning

confidence: 94%

“…Additionally, CRRT was associated with a significant benefit for in‐hospital (RR 0.7, 95% CI 0.52 to 0.94, I 2 = 0%, P = 0.02) and ICU (RR 0.64, 95% CI 0.43 to 0.96, I 2 = 0%, P = 0.03) renal recovery of all patients. Renal recovery for survivors was not significantly different between treatment modalities (in‐hospital: RR 0.94, 95% CI 0.8 to 1.11, I 2 = 0%, P = 0.47; ICU: RR 0.68, 95% CI 0.45 to 1.01, I 2 = 0%, P = 0.05) (Fig. ; Figs S1–S4).…”

Section: Resultsmentioning

confidence: 94%

“…Our literature search identified 374 articles; following deduplication, 236 unique articles were screened for inclusion. While 20 studies met a priori inclusion/exclusion criteria, one study was a published correction, and one was a companion, resulting in a total of 18 studies included in the systematic review (Fig. ).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 16 studies provided quantitative data on mortality, allowing for a meta‐analysis of results . Patients who received SLED were 79% less likely of dying compared with patients receiving CRRT, a statistically significant difference (RR 1.21, 95% CI 1.02 to 1.43, I 2 = 47%, P = 0.03) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Further, Chen et al (2012) reported no cases of severe intra‐dialytic hypotension in either group. Only one study showed a slight preference for CRRT relating to transient attacks of hypotension (CRRT: n = 1/40, 2.5%; SLED: n = 2/40, 5%); however, the statistical significance was not evaluated. Finally, one study evaluated hypotension solely in SLED patients, and thus, no conclusions could be made comparing CRRT with SLED …”

Section: Resultsmentioning

confidence: 99%

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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

et al. 2017

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This systematic review examines the impact of sustained low-efficiency dialysis or continuous renal replacement therapy on patient outcomes in critically ill patients with acute kidney injury. Meta-analysis indicated no statistically significant difference in the primary outcome of overall renal recovery (risk ratio 0.87, 95% confidence interval 0.63-1.20, I2 66%). There appears to be no clear advantage for continuous renal replacement in the haemodynamically unstable patient; however, there may be a mortality benefit for sustained low-efficiency dialysis. Currently, both modalities are safe and effective means of treating acute kidney injury in the critically ill adult. 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.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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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

et al. 2017

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Timing of renal replacement therapy initiation for acute kidney injury

Fayad

Buamscha

Ciapponi

2018

Cochrane Database of Systematic Reviews

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Background Acute kidney injury (AKI) is a common condition among patients in intensive care units (ICUs), and is associated with high death. Renal replacement therapy (RRT) is a blood purification technique used to treat the most severe forms of AKI. The optimal time to initiate RRT so as to improve clinical outcomes remains uncertain. This review complements another Cochrane review by the same authors: Intensity of continuous renal replacement therapy for acute kidney injury. Objectives To assess the effects of different timing (early and standard) of RRT initiation on death and recovery of kidney function in critically ill patients with AKI. Search methods We searched the Cochrane Kidney and Transplant's Specialised Register to 23 August 2018 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. We also searched LILACS to 11 September 2017. Selection criteria We included all randomised controlled trials (RCTs). We included all patients with AKI in ICU regardless of age, comparing early versus standard RRT initiation. For safety and cost outcomes we planned to include cohort studies and non-RCTs. Data collection and analysis Data were extracted independently by two authors. The random-effects model was used and results were reported as risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI).

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