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Sethi S, Mangat G, Soundararajan A, Marakini AB, Pecoits-Filho R, Shah R, Davenport A, Raina R. Archetypal sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring kidney replacement therapy: towards an adequate therapy. J Nephrol 2023; 36:1789-1804. [PMID: 37341966 DOI: 10.1007/s40620-023-01665-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/29/2023] [Indexed: 06/22/2023]
Abstract
Sustained low-efficiency dialysis is a hybrid form of kidney replacement therapy that has gained increasing popularity as an alternative to continuous forms of kidney replacement therapy in intensive care unit settings. During the COVID-19 pandemic, the shortage of continuous kidney replacement therapy equipment led to increasing usage of sustained low-efficiency dialysis as an alternative treatment for acute kidney injury. Sustained low-efficiency dialysis is an efficient method for treating hemodynamically unstable patients and is quite widely available, making it especially useful in resource-limited settings. In this review, we aim to discuss the various attributes of sustained low-efficiency dialysis and how it is comparable to continuous kidney replacement therapy in efficacy, in terms of solute kinetics and urea clearance, and the various formulae used to compare intermittent and continuous forms of kidney replacement therapy, along with hemodynamic stability. During the COVID-19 pandemic, there was increased clotting of continuous kidney replacement therapy circuits, which led to increased use of sustained low-efficiency dialysis alone or together with extra corporeal membrane oxygenation circuits. Although sustained low-efficiency dialysis can be delivered with continuous kidney replacement therapy machines, most centers use standard hemodialysis machines or batch dialysis systems. Even though antibiotic dosing differs between continuous kidney replacement therapy and sustained low-efficiency dialysis, reports of patient survival and renal recovery are similar for continuous kidney replacement therapy and sustained low-efficiency dialysis. Health care studies indicate that sustained low-efficiency dialysis has emerged as a cost-effective alternative to continuous kidney replacement therapy. Although there is considerable data to support sustained low-efficiency dialysis treatments for critically ill adult patients with acute kidney injury, there are fewer pediatric data, even so, currently available studies support the use of sustained low-efficiency dialysis for pediatric patients, particularly in resource-limited settings.
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Affiliation(s)
- Sidharth Sethi
- Department of Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Guneive Mangat
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
| | - Anvitha Soundararajan
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
| | - Abhilash Bhat Marakini
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
| | - Roberto Pecoits-Filho
- School of Medicine, Pontificia Universidade Catolica Do Parana, Curitiba, Brazil
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Raghav Shah
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London, London, UK
| | - Rupesh Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA.
- Department of Pediatric Nephrology, Akron Children's Hospital, Akron, OH, USA.
- Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.
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Wei W, Cai Z, Chen L, Yuan W, Fan Y, Rong S. Short-term prognostic models for severe acute kidney injury patients receiving prolonged intermittent renal replacement therapy based on machine learning. BMC Med Inform Decis Mak 2023; 23:133. [PMID: 37488514 PMCID: PMC10367369 DOI: 10.1186/s12911-023-02231-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND As an effective measurement for severe acute kidney injury (AKI), the prolonged intermittent renal replacement therapy (PIRRT) received attention. Also, machine learning has advanced and been applied to medicine. This study aimed to establish short-term prognosis prediction models for severe AKI patients who received PIRRT by machine learning. METHODS The hospitalized AKI patients who received PIRRT were assigned to this retrospective case-control study. They were grouped based on survival situation and renal recovery status. To screen the correlation, Pearson's correlation coefficient, partial ETA square, and chi-square test were applied, eight machine learning models were used for training. RESULTS Among 493 subjects, the mortality rate was 51.93% and the kidney recovery rate was 30.43% at 30 days post-discharge, respectively. The indices related to survival were Sodium, Total protein, Lactate dehydrogenase (LDH), Phosphorus, Thrombin time, Liver cirrhosis, chronic kidney disease stage, number of vital organ injuries, and AKI stage, while Sodium, Total protein, LDH, Phosphorus, Thrombin time, Diabetes, peripherally inserted central catheter and AKI stage were selected to predict the 30-day renal recovery. Naive Bayes has a good performance in the prediction model for survival, Random Forest has a good performance in 30-day renal recovery prediction model, while for 90-day renal recovery prediction model, it's K-Nearest Neighbor. CONCLUSIONS Machine learning can not only screen out indicators influencing prognosis of AKI patients receiving PIRRT, but also establish prediction models to optimize the risk assessment of these people. Moreover, attention should be paid to serum electrolytes to improve prognosis.
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Affiliation(s)
- Wenqian Wei
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhefei Cai
- Hangzhou Dianzi University, Hangzhou, China
| | - Lei Chen
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weijie Yuan
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingle Fan
- Hangzhou Dianzi University, Hangzhou, China.
| | - Shu Rong
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Dalbhi SA, Alorf R, Alotaibi M, Altheaby A, Alghamdi Y, Ghazal H, Almuzaini H, Negm H. Sustained low efficiency dialysis is non-inferior to continuous renal replacement therapy in critically ill patients with acute kidney injury: A comparative meta-analysis. Medicine (Baltimore) 2021; 100:e28118. [PMID: 34941056 PMCID: PMC8702221 DOI: 10.1097/md.0000000000028118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 11/16/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Critically ill adults with acute kidney injury (AKI) experience considerable morbidity and mortality. This systematic review aimed to compare the effectiveness of continuous renal replacement therapy (CCRT) versus sustained low efficiency dialysis (SLED) for individuals with AKI. METHODS We carried out a systematic search of existing databases according to standard methods and random effects models were used to generate the overall estimate. Heterogeneity coefficient was also calculated for each outcome measure. RESULTS Eleven studies having 1160 patients with AKI were included in the analyses. Meta-analysis results indicated that there was no statistically significant difference between SLED versus continuous renal replacement therapy (CRRT) in our primary outcomes, like mortality rate (rate ratio [RR] 0.67, 95% confidence interval [CI] 0.44-1.00; P = .05), renal recovery (RR 1.08, 95% CI 0.83-1.42; P = .56), and dialysis dependence (RR = 1.03, 95% CI 0.69-1.53; P = .89). Also, no statistically significant difference was observed for between SLED versus CRRT in the secondary outcomes: that is, length of intensive care unit stay (mean difference -0.16, 95% CI -0.56-0.22; P = .41) and fluid removal rate (mean difference -0.24, 95% CI -0.72-0.24; P = .32). The summary mean difference indicated that there was a significant difference in the serum phosphate clearance among patients treated with SLED and CRRT (mean difference -1.17, 95% CI -1.90 to -0.44, P = .002). CONCLUSIONS The analysis indicate that there was no major advantage of using continuous renal replacement compared with sustained low efficiency dialysis in hemodynamically unstable AKI patients. Both modalities are equally safe and effective in treating AKI among critically ill patients.
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Affiliation(s)
| | - Riyadh Alorf
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | | | - Yasser Alghamdi
- Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Hadeel Ghazal
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Helmy Negm
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Wei W, Rong S, Li X, Yang M, Gu L, Zhang Z, Chen L, Yuan W. Short-term prognosis and influencing factors of patients with acute kidney injury treated with prolonged intermittent renal replacement therapy. Int J Clin Pract 2021; 75:e14020. [PMID: 33426762 DOI: 10.1111/ijcp.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 01/07/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Studies assessing prognosis after prolonged intermittent renal replacement therapy (PIRRT) for acute kidney injury (AKI) are scarce. AIM To assess the impact of PIRRT on AKI and factors associated with short-term prognosis. METHODS In this retrospective nested case-control study, AKI patients administered PIRRT in Shanghai General Hospital from 01/2012 to 10/2018 were assigned to the 30-day survivor and death groups. Surviving patients were further divided into the kidney recovery and non-recovery groups at 30 and 90 days post-discharge, respectively. Propensity score matching was performed. RESULTS Totally 576 patients were included in the non-matched study population, mortality and kidney recovery rates were 51.7% and 33.4%, respectively. After propensity score matching, there were 250 patients in each of the death and survival groups. Low PIRRT frequency (OR = 2.165, 95% CI = 1.178-3.978), infection (OR = 0.447, 95% CI = 0.251-0.795), number of damaged vital organs (OR = 0.478, 95% CI = 0.346-0.661), sodium (OR = 0.958, 95% CI = 0.928-0.988), total protein (OR = 1.047, 95% CI = 1.022-1.072), pre-dialysis thrombin time (TT; OR = 0.959, 95% CI = 0.936-0.983), pre-discharge glomerular filtration rate (GFR; OR = 1.024, 95% CI = 1.017-1.031) and admission ward [reference: renal ward; intensive care unit (OR = 0.042, 95% CI = 0.008-0.211); surgery (OR = 0.092, 95% CI = 0.018-0.465); medical (OR = 0.049, 95% C% CI = 0.009-0.259); other (OR = 0.097, 95% CI = 0.016-0.572)] independently predicted 30-day mortality. Peripherally inserted central catheter (OR = 13.970, 95% CI = 1.439-135.589), urea nitrogen (OR = 0.961, 95% CI = 0.933-0.990) and pre-discharge GFR (OR = 1.102, 95% CI = 1.067-1.137) independently predicted 30-day kidney recovery. Pre-dialysis Scr (OR = 0.997, 95% CI = 0.995-0.999), urea nitrogen (OR = 0.948, 95% CI = 0.912-0.986) and pre-discharge GFR (OR = 1.137 95% CI = 1.088-1.189) independently predicted 90-day kidney recovery. CONCLUSIONS PIRRT improves survival and kidney function recovery in AKI patients. In patients with previous GFR ≥ 30 mL/(min-1.73 m2 ) and no prior maintenance dialysis, PIRRT at 3-5 sessions/week might be appropriate.
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Affiliation(s)
- Wenqian Wei
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu Rong
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xianchen Li
- Clinical Medical Research Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Man Yang
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lijie Gu
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheng Zhang
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Chen
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weijie Yuan
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zhao Y, Chen Y. Effect of renal replacement therapy modalities on renal recovery and mortality for acute kidney injury: A PRISMA-compliant systematic review and meta-analysis. Semin Dial 2020; 33:127-132. [PMID: 32149415 DOI: 10.1111/sdi.12861] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Previous investigations showed inconsistent results for comparison in renal recovery, in-hospital, and in-intensive care unit (ICU) mortalities between acute kidney injury (AKI) patients treated with continuous renal replacement therapy (CRRT) and some kinds of intermittent renal replacement therapies (IRRTs). We systematically searched for articles published in the databases (PubMed, Web of Science, EMBASE, Medline, and Google Scholar) until June 2019. We made all statistical analysis using STATA 12.0 software. In the present meta-analysis, relative risks with 95% confidence intervals were calculated for binary outcomes (renal recovery status or mortality). The present study indicated no significant differences in renal recovery, in-hospital mortality, and in-ICU mortality between AKI patients given CRRT and those given sustained low-efficiency dialysis (SLED). Additionally, the study showed no significant difference in in-hospital mortality between AKI patients given CRRT and those given intermittent hemodialysis (IHD), whereas elevated in-ICU mortality was detected in AKI patients given CRRT, compared to those given IHD. The three modalities (CRRT, IHD, and SLED) have their own advantages and disadvantages. More rigorous trials design with large cohort should be made to explore the differences in renal recovery, in-hospital, and in-ICU mortalities between different kinds of RRTs.
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Affiliation(s)
- Yuanyuan Zhao
- Department of Nephrology, Nanjing Lishui People's Hospital, Nanjing, Jiangsu, China.,Department of Nephrology, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, Jiangsu, China
| | - Yifei Chen
- Department of Emergency, The Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China
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Kovacs B, Sullivan KJ, Hiremath S, Patel RV. 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. Nephrology (Carlton) 2017; 22:343-353. [PMID: 28128881 DOI: 10.1111/nep.13009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/26/2016] [Accepted: 01/24/2017] [Indexed: 12/01/2022]
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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Affiliation(s)
- Bernadett Kovacs
- Department of Medicine, Montfort Hospital, Ottawa, Ontario, Canada
| | | | - Swapnil Hiremath
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Nephrology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Rakesh V Patel
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada
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Liu S, Zhong C, Chen J, Zhan J, He J, Zhu Y, Wang Y, Wang L, Ren L. Thermoresponsive Self-Assembled β-Cyclodextrin-Modified Surface for Blood Purification. ACS Biomater Sci Eng 2017; 3:1083-1091. [DOI: 10.1021/acsbiomaterials.7b00156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sa Liu
- School of Materials
Science and Engineering, South China University of Technology, Guangzhou 510641, China
| | - Chunting Zhong
- National
Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China
| | - Junjian Chen
- School of Materials
Science and Engineering, South China University of Technology, Guangzhou 510641, China
| | - Jiezhao Zhan
- National
Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China
| | - Jingcai He
- National
Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China
| | - Yuchen Zhu
- School of Materials
Science and Engineering, South China University of Technology, Guangzhou 510641, China
| | - Yingjun Wang
- School of Materials
Science and Engineering, South China University of Technology, Guangzhou 510641, China
| | - Lin Wang
- National
Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China
| | - Li Ren
- School of Materials
Science and Engineering, South China University of Technology, Guangzhou 510641, China
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Caires RA, Abdulkader RCRM, Costa E Silva VT, Ferreira GS, Burdmann EA, Yu L, Macedo E. Sustained low-efficiency extended dialysis (SLED) with single-pass batch system in critically-ill patients with acute kidney injury (AKI). J Nephrol 2015; 29:401-409. [PMID: 26298845 DOI: 10.1007/s40620-015-0224-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/31/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Single-pass batch dialysis (SBD) is a well-established system for treatment of end-stage renal disease. However, little evidence is available on sustained low-efficiency extended dialysis (SLED) performed with SBD in patients with acute kidney injury (AKI) in the intensive care unit (ICU). METHODS All SLED-SBD sessions conducted on AKI patients in nine ICUs between March and June 2010 were retrospectively analyzed regarding the achieved metabolic and fluid control. Logistic regression was performed to identify the risk factors associated with hypotension and clotting during the sessions. RESULTS Data from 106 patients and 421 sessions were analyzed. Patients were 54.2 ± 17.0 years old, 51 % males, and the main AKI cause was sepsis (68 %); 80 % of patients needed mechanical ventilation and 55 % vasoactive drugs. Hospital mortality was 62 %. The median session time was 360 min [interquartile range (IQR) 300-360] and prescribed ultrafiltration was 1500 ml (IQR 800-2000). In 272 sessions (65 %) no complications were recorded. No heparin was used in 269/421 procedures (64 %) and system clotting occurred in 63 sessions (15 %). Risk factors for clotting were sepsis [odds ratio (OR) 2.32 (1.31-4.11), p = 0.004], no anticoagulation [OR 2.94 (1.47-5.91), p = 0.002] and the prescribed time (hours) [OR 1.14 (1.05-1.24), p = 0.001]. Hypotension occurred in 25 % of procedures and no independent risk factors were identified by logistic regression. Adequate metabolic and fluid balance was achieved during SLED sessions. Median blood urea decreased from 107 to 63 mg/dl (p < 0.001), potassium from 4.1 to 3.9 mEq/l (p < 0.001), and increased bicarbonate (from 21.4 to 23.5 mEq/l, p < 0.001). Median fluid balance during session days ranged from +1300 to -20 ml/24 h (p < 0.001). CONCLUSIONS SLED-SBD was associated with a low incidence of clotting despite frequent use of saline flush, and achieved a satisfactory hemodynamic stability and reasonable metabolic and fluid control in critically-ill AKI patients.
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Affiliation(s)
- Renato A Caires
- Service of Nephrology, School of Medicine, University of Sao Paulo, Av. Doutor Arnaldo 251, Sao Paulo, SP, CEP: 01246-000, Brazil.
| | - Regina C R M Abdulkader
- Service of Nephrology, School of Medicine, University of Sao Paulo, Av. Doutor Arnaldo 251, Sao Paulo, SP, CEP: 01246-000, Brazil
| | - Verônica T Costa E Silva
- Service of Nephrology, School of Medicine, University of Sao Paulo, Av. Doutor Arnaldo 251, Sao Paulo, SP, CEP: 01246-000, Brazil
| | - Gillene S Ferreira
- Service of Nephrology, School of Medicine, University of Sao Paulo, Av. Doutor Arnaldo 251, Sao Paulo, SP, CEP: 01246-000, Brazil
| | - Emmanuel A Burdmann
- Service of Nephrology, School of Medicine, University of Sao Paulo, Av. Doutor Arnaldo 251, Sao Paulo, SP, CEP: 01246-000, Brazil
| | - Luis Yu
- Service of Nephrology, School of Medicine, University of Sao Paulo, Av. Doutor Arnaldo 251, Sao Paulo, SP, CEP: 01246-000, Brazil
| | - Etienne Macedo
- Service of Nephrology, School of Medicine, University of Sao Paulo, Av. Doutor Arnaldo 251, Sao Paulo, SP, CEP: 01246-000, Brazil
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Zhang L, Yang J, Eastwood GM, Zhu G, Tanaka A, Bellomo R. Extended Daily Dialysis Versus Continuous Renal Replacement Therapy for Acute Kidney Injury: A Meta-analysis. Am J Kidney Dis 2015; 66:322-30. [PMID: 25843704 DOI: 10.1053/j.ajkd.2015.02.328] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 02/13/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Extended daily dialysis (EDD) has been suggested as an effective renal replacement therapy for acute kidney injury. However, results from studies comparing EDD to continuous renal replacement therapy (CRRT) are inconclusive. STUDY DESIGN A systematic review and meta-analysis was performed by searching in MEDLINE, EMBASE, the Cochrane Library, Google Scholar, and a Chinese database (SinsoMed). SETTING & POPULATION Patients with acute kidney injury. SELECTION CRITERIA FOR STUDIES Randomized controlled trials (RCTs) and observational studies were included. EDD was defined as extended hemodialysis or hemodiafiltration for more than 6 but less than 24 hours per session using a conventional hemodialysis machine. INTERVENTION Renal replacement therapy comparing EDD with CRRT. OUTCOMES Mortality, kidney recovery, and fluid removal. RESULTS We included 17 studies from 2000 to 2014: 7 RCTs and 10 observational studies involving 533 and 675 patients, respectively. Meta-analysis of RCTs showed no difference in mortality rates between EDD and CRRT (relative risk, 0.90; 95% CI, 0.74-1.11; P=0.3). However, EDD was associated with lower mortality risk compared with CRRT in observational studies (relative risk, 0.86; 95% CI, 0.74-1.00; P=0.05). There was no evidence of heterogeneity in RCTs (I(2)=0%) or observational studies (I(2)=15%). In both RCTs and observational studies, there were no significant differences in recovery of kidney function, fluid removal, or days in the intensive care unit, and EDD showed similar biochemical efficacy to CRRT during treatment (serum urea, serum creatinine, and serum phosphate). LIMITATIONS The survival benefit of EDD is dependent on only observational studies and might have been affected by allocation or selection bias. CONCLUSIONS EDD is associated with similar outcomes to CRRT in RCTs. The finding that EDD is associated with a lower mortality rate relies on data from observational studies, which are potentially subject to allocation or selection bias, making further high-quality RCTs desirable.
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Affiliation(s)
- Ling Zhang
- Division of Nephrology, West China Hospital of Sichuan University, Sichuan, Chengdu, China; Division of Intensive Care Unit, Austin Health, Heidelberg, VIC, Australia
| | - Jiqiao Yang
- West China School of Medicine, Sichuan University, Sichuan, Chengdu, China
| | - Glenn M Eastwood
- Division of Intensive Care Unit, Austin Health, Heidelberg, VIC, Australia
| | - Guijun Zhu
- Division of Intensive Care Unit, Austin Health, Heidelberg, VIC, Australia; Division of Intensive Care Unit, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Aiko Tanaka
- Division of Intensive Care Unit, Austin Health, Heidelberg, VIC, Australia
| | - Rinaldo Bellomo
- Division of Intensive Care Unit, Austin Health, Heidelberg, VIC, Australia.
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