Abstract
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.
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References
Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818
Kellum JA, Angus DC, Johnson JP, Leblanc M, Griffin M, Ramakrishnan N, Linde-Zwirble WT (2002) Continuous versus intermittent renal replacement therapy: a meta-analysis. Intensive Care Med 28:29–37
Kierdorf H (1991) Continuous versus intermittent treatment: clinical results in acute renal failure. Contrib Nephrol 93:1–12
Bosworth C, Paganini EP, Cosentino F, Heyka RJ (1991) Long-term experience with continuous renal replacement therapy in intensive-care unit acute renal failure. Contrib Nephrol 93:13–16
Kruczynski K, Irvine-Bird K, Toffelmire EB, Morton AR (1993) A comparison of continuous arteriovenous hemofiltration and intermittent hemodialysis in acute renal failure patients in the intensive care unit. ASAIO J 39:M778–M781
Rialp G, Roglan A, Betbese AJ, Perez-Marquez M, Ballus J, Lopez-Velarde G, Santos JA, Bak E, Net A (1996) Prognostic indexes and mortality in critically ill patients with acute renal failure treated with different dialytic techniques. Ren Fail 18:667–675
Swartz RD, Messana JM, Orzol S, Port FK (1999) Comparing continuous hemofiltration with hemodialysis in patients with severe acute renal failure. Am J Kidney Dis 34:424–432
Uehlinger DE, Jakob SM, Ferrari P, Eichelberger M, Huynh-Do U, Marti HP, Mohaupt MG, Vogt B, Rothen HU, Regli B, Takala J, Frey FJ (2005) Comparison of continuous and intermittent renal replacement therapy for acute renal failure. Nephrol Dial Transpl 20:1630–1637
Augustine JJ, Sandy D, Seifert TH, Paganini EP (2004) A randomized controlled trial comparing intermittent with continuous dialysis in patients with ARF. Am J Kidney Dis 44:1000–1007
Rabindranath K, Adams J, Macleod AM, Muirhead N (2007) Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database Syst Rev: CD003773
Pannu N, Klarenbach S, Wiebe N, Manns B, Tonelli M (2008) Renal replacement therapy in patients with acute renal failure: a systematic review. JAMA 299:793–805
Bagshaw SM, Berthiaume LR, Delaney A, Bellomo R (2008) Continuous versus intermittent renal replacement therapy for critically ill patients with acute kidney injury: a meta-analysis. Crit Care Med 36:610–617
Gopal I, Bhonagiri S, Ronco C, Bellomo R (1997) Out of hospital outcome and quality of life in survivors of combined acute multiple organ and renal failure treated with continuous venovenous hemofiltration/hemodiafiltration. Intensive Care Med 23:766–772
Go AS, Parikh CR, Ikizler TA, Coca S, Siew ED, Chinchilli VM, Hsu CY, Garg AX, Zappitelli M, Liu KD, Reeves WB, Ghahramani N, Devarajan P, Faulkner GB, Tan TC, Kimmel PL, Eggers P, Stokes JB (2010) The assessment, serial evaluation, and subsequent sequelae of acute kidney injury (ASSESS-AKI) study: design and methods. BMC Nephrol 11:22
Parikh CR, Coca SG, Smith GL, Vaccarino V, Krumholz HM (2006) Impact of chronic kidney disease on health-related quality-of-life improvement after coronary artery bypass surgery. Arch Intern Med 166:2014–2019
Parikh A, Shaw A (2012) The economics of renal failure and kidney disease in critically ill patients. Crit Care Clin 28: 99–111, vii
Mehta RL, McDonald B, Gabbai FB, Pahl M, Pascual MT, Farkas A, Kaplan RM, Collaborative Group for Treatment of ARFitICU (2001) A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int 60:1154–1163
Jadad AR, Murray WE (2007) Randomized controlled trials: questions, answers and musings. Blackwell, Oxford
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188
Schneider AG, Lipcsey M, Bailey M, Pilcher DV, Bellomo R (2012) Relationship between illness severity scores in acute kidney injury. Crit Care Resusc 14:53–55
Abe M, Okada K, Suzuki M, Nagura C, Ishihara Y, Fujii Y, Ikeda K, Kaizu K, Matsumoto K (2010) Comparison of sustained hemodiafiltration with continuous venovenous hemodiafiltration for the treatment of critically ill patients with acute kidney injury. Artif Organs 34:331–338
Kumar VA, Yeun JY, Depner TA, Don BR (2004) Extended daily dialysis vs. continuous hemodialysis for ICU patients with acute renal failure: a two-year single center report. Int J Artif Organs 27:371–379
Lins RL, Elseviers MM, Van der Niepen P, Hoste E, Malbrain ML, Damas P, Devriendt J (2009) Intermittent versus continuous renal replacement therapy for acute kidney injury patients admitted to the intensive care unit: results of a randomized clinical trial. Nephrol Dial Transpl 24:512–518
Vinsonneau C, Camus C, Combes A, Costa de Beauregard MA, Klouche K, Boulain T, Pallot J-L, Chiche J-D, Taupin P, Landais P, Dhainaut J-F, Hemodiafe Study Group (2006) Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial. Lancet 368:379–385
Andrikos E, Tseke P, Balafa O, Cruz DN, Tsinta A, Androulaki M, Pappas M, Ronco C (2009) Epidemiology of acute renal failure in ICUs: a multi-center prospective study. Blood Purif 28:239–244
Bagshaw SM, Mortis G, Godinez-Luna T, Doig CJ, Laupland KB (2006) Renal recovery after severe acute renal failure. Int J Artif Organs 29:1023–1030
Bell M, Granath F, Schon S, Ekbom A, Martling CR (2007) Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure. Intensive Care Med 33:773–780
Cartin-Ceba R, Haugen EN, Iscimen R, Trillo-Alvarez C, Juncos L, Gajic O (2009) Evaluation of “loss” and “end stage renal disease” after acute kidney injury defined by the risk, injury, failure, loss and ESRD classification in critically ill patients. Intensive Care Med 35:2087–2095
Chang JW, Yang WS, Seo JW, Lee JS, Lee SK, Park S-K (2004) Continuous venovenous hemodiafiltration versus hemodialysis as renal replacement therapy in patients with acute renal failure in the intensive care unit. Scand J Urol Nephrol 38:417–421
Elseviers MM, Lins RL, Van der Niepen P, Hoste E, Malbrain ML, Damas P, Devriendt J, SHARF Investigators (2010) Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury. Crit Care 14:R221
Garcia-Fernandez N, Perez-Valdivieso JR, Bes-Rastrollo M, Vives M, Lavilla J, Herreros J, Monedero P, GEDRCC (2011) Timing of renal replacement therapy after cardiac surgery: a retrospective multicenter Spanish cohort study. Blood Purif 32:104–111
Gonwa TA, Mai ML, Melton LB, Hays SR, Goldstein RM, Levy MF, Klintmalm GB (2001) Renal replacement therapy and orthotopic liver transplantation: the role of continuous veno-venous hemodialysis. Transplantation 71:1424–1428
Jacka MJ, Ivancinova X, Gibney RTN (2005) Continuous renal replacement therapy improves renal recovery from acute renal failure. Can J Anaesth 52:327–332
Lin Y-F, Ko W-J, Chu T-S, Chen Y-S, Wu V-C, Chen Y-M, Wu M-S, Chen Y-W, Tsai C-W, Shiao C-C, Li W-Y, Hu F-C, Tsai P-R, Tsai T-J, Wu K-D, NSARF Study Group (2009) The 90-day mortality and the subsequent renal recovery in critically ill surgical patients requiring acute renal replacement therapy. Am J Surg 198:325–332
Lins RL, Elseviers MM, Daelemans R (2006) Severity scoring and mortality 1 year after acute renal failure. Nephrol Dial Transpl 21:1066–1068
Marshall MR, Creamer JM, Foster M, Ma TM, Mann SL, Fiaccadori E, Maggiore U, Richards B, Wilson VL, Williams AB, Rankin APN (2011) Mortality rate comparison after switching from continuous to prolonged intermittent renal replacement for acute kidney injury in three intensive care units from different countries. Nephrol Dial Transpl 26:2169–2175
Park J, Gage BF, Vijayan A (2005) Use of EPO in critically ill patients with acute renal failure requiring renal replacement therapy. Am J Kidney Dis 46:791–798
Swartz RD, Bustami RT, Daley JM, Gillespie BW, Port FK (2005) Estimating the impact of renal replacement therapy choice on outcome in severe acute renal failure. Clin Nephrol 63:335–345
Uchino S, Bellomo R, Kellum JA, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Oudemans-Van Straaten H, Ronco C (2007) Patient and kidney survival by dialysis modality in critically ill patients with acute kidney injury. Int J Artif Organs 30:281–292
Waldrop J, Ciraulo DL, Milner TP, Gregori ID, Kendrick AS, Richart CM, Maxwell RA, Barker DE (2005) A comparison of continuous renal replacement therapy to intermittent dialysis in the management of renal insufficiency in the acutely ill surgical patient. Am Surg 71:36–39
Khanal N, Marshall MR, Ma TM, Pridmore PJ, Williams AB, Rankin APN (2012) Comparison of outcomes by modality for critically ill patients requiring renal replacement therapy: a single-centre cohort study adjusting for time-varying illness severity and modality exposure. Anaesth Intensive Care 40:260–268
Albright RC, Smelser JM, McCarthy JT, Homburger HA, Bergstralh EJ, Larson TS (2000) Patient survival and renal recovery in acute renal failure: randomized comparison of cellulose acetate and polysulfone membrane dialyzers. Mayo Clin Proc 75:1141–1147
Bahar I, Akgul A, Ozatik MA, Vural KM, Demirbag AE, Boran M, Tasdemir O (2005) Acute renal failure following open heart surgery: risk factors and prognosis. Perfusion 20:317–322
Faulhaber-Walter R, Hafer C, Jahr N, Vahlbruch J, Hoy L, Haller H, Fliser D, Kielstein JT (2009) The Hannover Dialysis Outcome study: comparison of standard versus intensified extended dialysis for treatment of patients with acute kidney injury in the intensive care unit. Nephrol Dial Transpl 24:2179–2186
Gabriel DP, Caramori JT, Martim LC, Barretti P, Balbi AL (2008) High volume peritoneal dialysis vs daily hemodialysis: a randomized, controlled trial in patients with acute kidney injury. Kidney Int 73(Suppl 108):S87–S93
Kumpers P, Hafer C, David S, Hecker H, Lukasz A, Fliser D, Haller H, Kielstein JT, Faulhaber-Walter R (2010) Angiopoietin-2 in patients requiring renal replacement therapy in the ICU: relation to acute kidney injury, multiple organ dysfunction syndrome and outcome. Intensive Care Med 36:462–470
Holt BG, White JJ, Kuthiala A, Fall P, Szerlip HM (2008) Sustained low-efficiency daily dialysis with hemofiltration for acute kidney injury in the presence of sepsis. Clin Nephrol 69:40–46
Franzen D, Rupprecht C, Hauri D, Bleisch JA, Staubli M, Puhan MA (2010) Predicting outcomes in critically ill patients with acute kidney injury undergoing intermittent hemodialysis—a retrospective cohort analysis. Int J Artif Organs 33:15–21
Iyem H, Tavli M, Akcicek F, Buket S (2009) Importance of early dialysis for acute renal failure after an open-heart surgery. Hemodial Int 13:55–61
Ponikvar JB, Rus RR, Kenda RB, Bren AF, Ponikvar RR (2001) Low-flux versus high-flux synthetic dialysis membrane in acute renal failure: prospective randomized study. Artif Organs 25:946–950
Schiffl H, Lang SM, Fischer R (2002) Daily hemodialysis and the outcome of acute renal failure. N Engl J Med 346:305–310
Al-Malki H, Sadek M, Rashed A, Asim M, Fituri O, Abbass M (2009) Acute renal failure in the State of Qatar: presentation and outcome. Transpl Proc 41:1530–1532
Boussekey N, Chiche A, Faure K, Devos P, Guery B, D’Escrivan T, Georges H, Leroy O (2008) A pilot randomized study comparing high and low volume hemofiltration on vasopressor use in septic shock. Intensive Care Med 34:1646–1653
Beitland S, Moen H, Os I (2010) Acute kidney injury with renal replacement therapy in trauma patients. Acta Anaesthesiol Scand 54:833–840
Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lo S, McArthur C, McGuinness S, Myburgh J, Norton R, Scheinkestel C, Su S (2009) Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med 361:1627–1638
Ng KP, Chanouzas D, Fallouh B, Baharani J (2012) Short and long-term outcome of patients with severe acute kidney injury requiring renal replacement therapy. QJM 105:33–39
Saudan P, Niederberger M, De Seigneux S, Romand J, Pugin J, Perneger T, Martin PY (2006) Adding a dialysis dose to continuous hemofiltration increases survival in patients with acute renal failure. Kidney Int 70:1312–1317
Van Der Voort PHJ, Boerma EC, Koopmans M, Zandberg M, De Ruiter J, Gerritsen RT, Egbers PHM, Kingma WP, Kuiper MA (2009) Furosemide does not improve renal recovery after hemofiltration for acute renal failure in critically ill patients: a double blind randomized controlled trial. Crit Care Med 37:533–538
Bouman CS, Oudemans-Van Straaten HM, Tijssen JG, Zandstra DF, Kesecioglu J (2002) Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial. Crit Care Med 30:2205–2211
Chung KK, Juncos LA, Wolf SE, Mann EE, Renz EM, White CE, Barillo DJ, Clark RA, Jones JA, Edgecombe HP, Park MS, Albrecht MC, Cancio LC, Wade CE, Holcomb JB (2008) Continuous renal replacement therapy improves survival in severely burned military casualties with acute kidney injury. J Trauma Inj Infect Crit Care 64:S179–S185 (discussion S185–177)
Kowalik MM, Lango R, Klajbor K, Musial-Swiatkiewicz V, Kolaczkowska M, Pawlaczyk R, Rogowski J (2011) Incidence- and mortality-related risk factors of acute kidney injury requiring hemofiltration treatment in patients undergoing cardiac surgery: a single-center 6-year experience. J Cardiothorac Vasc Anesth 25:619–624
Lines SW, Cherukuri A, Murdoch SD, Bellamy MC, Lewington AJP (2011) The outcomes of critically ill patients with acute kidney injury receiving renal replacement therapy. Int J Artif Organs 34:2–9
Luckraz H, Gravenor MB, George R, Taylor S, Williams A, Ashraf S, Argano V, Youhana A (2005) Long and short-term outcomes in patients requiring continuous renal replacement therapy post cardiopulmonary bypass. Eur J Cardiothorac Surg 27:906–909
Oudemans-van Straaten HM, Bosman RJ, Koopmans M, van der Voort PH, Wester JP, van der Spoel JI, Dijksman LM, Zandstra DF (2009) Citrate anticoagulation for continuous venovenous hemofiltration. Crit Care Med 37:545–552
Soubrier S, Leroy O, Devos P, Nseir S, Georges H, d’Escrivan T, Guery B (2006) Epidemiology and prognostic factors of critically ill patients treated with hemodiafiltration. J Crit Care 21:66–72
Tolwani AJ, Campbell RC, Stofan BS, Lai KR, Oster RA, Wille KM (2008) Standard versus high-dose CVVHDF for ICU-related acute renal failure. J Am Soc Nephrol 19:1233–1238
Vats HS, Dart RA, Okon TR, Liang H, Paganini EP (2011) Does early initiation of continuous renal replacement therapy affect outcome: experience in a tertiary care center. Ren Fail 33:698–706
Hussain S, Piering W, Mohyuddin T, Saleh M, Zhu Y-R, Hannan M, Cohen E (2009) Outcome among patients with acute renal failure needing continuous renal replacement therapy: a single center study. [Erratum appears in Hemodial Int. 2010 Jan; 14(1):152 Note: Hanan, Mary [corrected to Hannan, Mary]]. Hemodial Int 13:205–214
Rabindranath KS, Adams J, Shail R, Macleod AM, Muirhead N (2009) Does dialysis therapy modality matter in acute renal failure? A systematic review of randomised controlled trials comparing intermittent and continuous renal replacement therapy. Br J Intensive Care 19:110–121
Kelleher SP, Robinette JB, Miller F, Conger JD (1987) Effect of hemorrhagic reduction in blood pressure on recovery from acute renal failure. Kidney Int 31:725–730
Adams PL, Adams FF, Bell PD, Navar LG (1980) Impaired renal blood flow autoregulation in ischemic acute renal failure. Kidney Int 18:68–76
Matthys E, Patton MK, Osgood RW, Venkatachalam MA, Stein JH (1983) Alterations in vascular function and morphology in acute ischemic renal failure. Kidney Int 23:717–724
Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM, Smith MW, Swanson KM, Thompson BT, Vijayan A, Watnick S, Star RA, Peduzzi P (2008) Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 359:7–20
Davenport A (2006) Intradialytic complications during hemodialysis. Hemodial Int 10:162–167
Manns M, Sigler MH, Teehan BP (1997) Intradialytic renal haemodynamics–potential consequences for the management of the patient with acute renal failure. Nephrol Dial Transpl 12:870–872
Lameire N, Van Biesen W, Vanholder R, Colardijn F (1998) The place of intermittent hemodialysis in the treatment of acute renal failure in the ICU patient. Kidney Int Suppl 66:S110–S119
Abdeen O, Mehta RL (2002) Dialysis modalities in the intensive care unit. Crit Care Clin 18:223–247
Selby NM, Lambie SH, Camici PG, Baker CS, McIntyre CW (2006) Occurrence of regional left ventricular dysfunction in patients undergoing standard and biofeedback dialysis. Am J Kidney Dis 47:830–841
Burton JO, Jefferies HJ, Selby NM, McIntyre CW (2009) Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Clin J Am Soc Nephrol 4:1925–1931
Davenport A, Will EJ, Davidson AM (1993) Improved cardiovascular stability during continuous modes of renal replacement therapy in critically ill patients with acute hepatic and renal failure. Crit Care Med 21:328–338
Van der Schueren G, Diltoer M, Laureys M, Huyghens L (1996) Intermittent hemodialysis in critically ill patients with multiple organ dysfunction syndrome is associated with intestinal intramucosal acidosis. Intensive Care Med 22:747–751
Conger JD (1990) Does hemodialysis delay recovery from acute renal failure? Semin Dial 3:146–148
Kramer JR, Hertzer NR, Taylor PC (1977) Traumatic arterial embolism producing arteriovenous fistula. Heart Lung 6:1023–1026
Kohen JA, Whitley KY, Kjellstrand CM (1985) Continuous arteriovenous hemofiltration: a comparison with hemodialysis in acute renal failure. Trans Am Soc Artif Intern Organs 31:169–175
Baldwin IC, Elderkin TD (1995) Continuous hemofiltration: nursing perspectives in critical care. New Horiz 3:738–747
Yang L, Besschetnova TY, Brooks CR, Shah JV, Bonventre JV (2010) Epithelial cell cycle arrest in G2/M mediates kidney fibrosis after injury. Nat Med 16:535–543 (531 p following 143)
Hayes JA, Black NA, Jenkinson C, Young JD, Rowan KM, Daly K, Ridley S (2000) Outcome measures for adult critical care: a systematic review. Health Technol Assess 4:1–111
Ramsay P (2011) Health-related quality of life: implications for critical care interventional studies and why we need to collaborate with patients. Curr Opin Crit Care 17:510–514
Johansen KL, Smith MW, Unruh ML, Siroka AM, O’Connor TZ, Palevsky PM (2010) 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. Clin J Am Soc Nephrol 5:1366–1372
Acknowledgments
We thank Drs. Vijayan, Lins, Ahlstrom, Andrikos, Garcia-Fernandes, and Marshall for making data available. This study was funded by the Austin Hospital Anaesthesia and Intensive Care Trust Fund. Preliminary results of this study were presented at the 32nd ISICEM conference and published as an abstract in Critical Care. Dr. Bagshaw is supported by a Canada Research Chair in Critical Care Nephrology and Clinical Investigator Award from Alberta Innovates-Health Solutions.
Conflicts of interest
Drs. Bellomo and Bagshaw have acted as occasional paid consultant for Gambro Pty ltd over the last five years. All other authors stated that they had no conflicts of interest to declare.
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Schneider, A.G., Bellomo, R., Bagshaw, S.M. et al. Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis. Intensive Care Med 39, 987–997 (2013). https://doi.org/10.1007/s00134-013-2864-5
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DOI: https://doi.org/10.1007/s00134-013-2864-5