Utilization of slow low-efficiency dialysis may help to optimize the need for continuous renal replacement therapy in Indian ICUs

Majumdar, Arghya; Basu, Surupa; Bhattacharya, M; Kharbanda, Mohit; Sinha, Piyush Kumar; Todi, Subhash

doi:10.1186/cc7435

Cited by 1 publication

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“…). Subgroup meta‐analysis for 30 day mortality also significantly favoured SLED (RR 1.36, 95% CI 1.06 to 1.75, I 2 = 0%, P = 0.02); however, subgroups based on location (hospital or ICU) revealed a non‐significant difference (hospital: RR 1.12, 95% CI 0.9 to 1.4, I 2 = 56%, P = 0.32; ICU: RR 1.44, 95% CI 0.93 to 2.24, I 2 = 56%, P = 0.1) (Fig. ; S6–S8).…”

Section: Resultsmentioning

confidence: 94%

“…Our literature search identified 374 articles; following deduplication, 236 unique articles were screened for inclusion. While 20 studies met a priori inclusion/exclusion criteria, one study was a published correction, and one was a companion, resulting in a total of 18 studies included in the systematic review (Fig. ).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 16 studies provided quantitative data on mortality, allowing for a meta‐analysis of results . Patients who received SLED were 79% less likely of dying compared with patients receiving CRRT, a statistically significant difference (RR 1.21, 95% CI 1.02 to 1.43, I 2 = 47%, P = 0.03) (Fig.…”

Section: Resultsmentioning

confidence: 99%

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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

et al. 2017

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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.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%