Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis.

Détails

ID Serval
serval:BIB_94B9D911CA88
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis.
Périodique
Intensive Care Medicine
Auteur(s)
Schneider A.G., Bellomo R., Bagshaw S.M., Glassford N.J., Lo S., Jun M., Cass A., Gallagher M.
ISSN
1432-1238 (Electronic)
ISSN-L
0342-4642
Statut éditorial
Publié
Date de publication
2013
Peer-reviewed
Oui
Volume
39
Numéro
6
Pages
987-997
Langue
anglais
Notes
Publication types: Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review Publication Status: ppublish
Résumé
PURPOSE: 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)].
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
Mots-clé
Acute Kidney Injury/therapy, Decision Making, Humans, Outcome and Process Assessment (Health Care), Renal Dialysis, Renal Replacement Therapy/methods, Risk Factors
Pubmed
Web of science
Création de la notice
26/11/2014 22:29
Dernière modification de la notice
20/08/2019 15:57
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