Patients with severe acute kidney injury (AKI) initially treated with intermittent rather than continuous renal replacement therapy (RRT) may be more likely to become dialysis dependent, researchers reported online in Intensive Care Medicine.
Antoine G. Schneider, MD, of Austin Health in Heidelberg, Victoria, Australia, and colleagues conducted a systematic review and meta-analysis of 23 studies of dialysis dependence among survivors of severe AKI treated with either intermittent RRT ((IRRT) and continuous RRT (CRRT). The 23 studies included seven randomized controlled trials (RCTs) that included 472 patients and 16 observational studies that included 3,499 patients. Overall, initial treatment with IRRT was associated with a 1.7 times increased relative risk for dialysis dependence compared with CRRT.
Pooled analyses of the RCTs demonstrated no significant difference in dialysis dependent rates between the modalities, but pooled analyses of the observational studies showed that patients who initially received IRRT had a twofold increased risk of dialysis dependence compared with CRRT. The investigators acknowledged that the observational studies “might be associated with allocation bias and given the human and public health implications of these findings, large studies focusing on renal recovery after AKI according to choice of RRT are needed to fully understand the effects of initial modality choice on subsequent dialysis dependence.”