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

Abstract

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.

Effect of renal replacement therapy modalities on renal recovery and mortality for acute kidney injury: A PRISMA‐compliant systematic review and meta‐analysis

“…Results regarding to comparison in renal recovery, in-hospital mortality, and in-ICU mortality between AKI patients given CRRT and those given SLED were corresponding to previous studies 4,30 published in recent years. According to previous studies, worse baseline renal function and more frequent intradialytic hypotension were associated with lower likelihood of renal recovery.…”

Renal Replacement Therapy in the Critical Care Setting

“…Fluid accumulation is an independent risk factor for poor prognosis in MOF, and CRRT has been shown to be superior at overall fluid removal compared to IHD [13]. Sustained low-efficiency dialysis (SLED) has comparable haemodynamic outcomes and can be considered in MOF [48].…”

Issues of Acute Kidney Injury Staging and Management in Sepsis and Critical Illness: A Narrative Review

“…Despite these theoretical advantages of hemofiltration, the data on this issue is inconclusive. However, the hemodynamic instability during dialysis is not that relevant in clinical practice, especially in the Age of hybrid procedures like sustained low efficiency dialysis (SLED) [ 180 , 181 , 182 , 183 ]. In this context, observational studies have shown a tendency towards improved renal recovery under continuous hemofiltration, whereas a recent meta-analysis (excluding observational studies) and RCTs showed no difference [ 184 , 185 , 186 , 187 ].…”