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Related Experiment Videos

Continuous versus intermittent renal replacement therapy: a meta-analysis.

John A Kellum1, Derek C Angus, John P Johnson

  • 1Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh Medical Center, Division of Critical Care Medicine, 200 Lothrop Street, Pittsburgh, PA 15213-2582, USA. kellumja@anes.upmc.edu

Intensive Care Medicine
|January 31, 2002
PubMed
Summary

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Continuous renal replacement therapy (CRRT) may improve survival in critically ill patients with acute renal failure compared to intermittent hemodialysis (IRRT). Further large randomized trials are needed to confirm these findings for acute kidney injury treatment.

Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Intensive Care Unit Management

Background:

  • Acute renal failure is common in critically ill patients.
  • Mechanical support via continuous renal replacement therapy (CRRT) or intermittent hemodialysis (IRRT) is often required.
  • The optimal modality for acute kidney injury in critical illness remains debated.

Purpose of the Study:

  • To compare the survival outcomes of CRRT versus IRRT in critically ill patients.
  • To analyze existing studies to determine the association between CRRT or IRRT and hospital mortality.
  • To inform clinical practice regarding renal replacement therapy in critical care.

Main Methods:

  • A meta-analysis of randomized and observational studies was conducted.
  • Studies were identified via MEDLINE, author files, and scientific meeting abstracts.

Related Experiment Videos

  • Hospital mortality was the primary endpoint, assessed using cumulative relative risk (RR).

    • Main Results:

    • Thirteen studies with 1400 patients were analyzed; only three were randomized.
    • Overall, no significant difference in mortality was observed (RR 0.93).
    • However, after adjusting for study quality and illness severity, CRRT was associated with lower mortality (RR 0.72, p<0.01).

    Conclusions:

    • Existing evidence is limited for definitive conclusions on CRRT versus IRRT in acute renal failure.
    • Secondary analyses suggest a potential survival benefit with CRRT.
    • A large, randomized trial is recommended to investigate the life-saving potential of CRRT.