Renal replacement therapy intensity for acute kidney injury and recovery to dialysis independence: A systematic review and individual patient data meta-analysis

Ying Wang; Martin Gallagher; Qiang Li; Serigne Lo; Alan Cass; Simon Finfer; John Myburgh; Catherine Bouman; Robert Faulhaber-Walter; John A. Kellum; Paul M. Palevsky; Claudio Ronco; Patrick Saudan; Ashita Tolwani; Rinaldo Bellomo

doi:10.1093/ndt/gfx308

Renal replacement therapy intensity for acute kidney injury and recovery to dialysis independence: A systematic review and individual patient data meta-analysis

Ying Wang, Martin Gallagher, Qiang Li, Serigne Lo, Alan Cass, Simon Finfer, John Myburgh, Catherine Bouman, Robert Faulhaber-Walter, John A. Kellum, Paul M. Palevsky, Claudio Ronco, Patrick Saudan, Ashita Tolwani, Rinaldo Bellomo

Wellbeing and Preventable Chronic Disease

Research output: Contribution to journal › Article › peer-review

50 Citations (Scopus)

Abstract

Background: There is no consensus whether higher intensity dose renal replacement therapy (RRT) compared with standard intensity RRT has survival benefit and achieves better renal recovery in acute kidney injury (AKI).

Methods: In an individual patient data meta-analysis, we merged individual patient data from randomized controlled trials (RCTs) comparing high with standard intensity RRT in intensive care unit patients with severe AKI. The primary outcome was all-cause mortality. The secondary outcome was renal recovery assessed as the proportion of patients who were RRT dependent at key trial endpoints and by time to the end of RRT dependence.

Results: Of the eight prospective RCTs assessing different RRT intensities, seven contributed individual patient data (n = 3682) to the analysis. Mortality was similar between the two groups at 28 days [769/1884 (40.8%) and 744/1798 (41.4%), respectively; P = 0.40] after randomization. However, more participants assigned to higher intensity therapy remained RRT dependent at the most common key study point of 28 days [e.g. 292/983 (29.7%) versus 235/943 (24.9%); relative risk 1.15 (95% confidence interval 1.00-1.33); P = 0.05]. Time to cessation of RRT through 28 days was longer in patients receiving higher intensity RRT (log-rank test P = 0.02) and when continuous renal replacement therapy was used as the initial modality of RRT (log-rank test P = 0.03).

Conclusions: In severe AKI patients, higher intensity RRT does not affect mortality but appears to delay renal recovery.

Original language	English
Pages (from-to)	1017-1024
Number of pages	8
Journal	Nephrology Dialysis Transplantation
Volume	33
Issue number	6
DOIs	https://doi.org/10.1093/ndt/gfx308
Publication status	Published - 1 Jun 2018

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Wang, Y., Gallagher, M., Li, Q., Lo, S., Cass, A., Finfer, S., Myburgh, J., Bouman, C., Faulhaber-Walter, R., Kellum, J. A., Palevsky, P. M., Ronco, C., Saudan, P., Tolwani, A., & Bellomo, R. (2018). Renal replacement therapy intensity for acute kidney injury and recovery to dialysis independence: A systematic review and individual patient data meta-analysis. Nephrology Dialysis Transplantation, 33(6), 1017-1024. https://doi.org/10.1093/ndt/gfx308

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title = "Renal replacement therapy intensity for acute kidney injury and recovery to dialysis independence: A systematic review and individual patient data meta-analysis",

abstract = "Background: There is no consensus whether higher intensity dose renal replacement therapy (RRT) compared with standard intensity RRT has survival benefit and achieves better renal recovery in acute kidney injury (AKI). Methods: In an individual patient data meta-analysis, we merged individual patient data from randomized controlled trials (RCTs) comparing high with standard intensity RRT in intensive care unit patients with severe AKI. The primary outcome was all-cause mortality. The secondary outcome was renal recovery assessed as the proportion of patients who were RRT dependent at key trial endpoints and by time to the end of RRT dependence. Results: Of the eight prospective RCTs assessing different RRT intensities, seven contributed individual patient data (n = 3682) to the analysis. Mortality was similar between the two groups at 28 days [769/1884 (40.8%) and 744/1798 (41.4%), respectively; P = 0.40] after randomization. However, more participants assigned to higher intensity therapy remained RRT dependent at the most common key study point of 28 days [e.g. 292/983 (29.7%) versus 235/943 (24.9%); relative risk 1.15 (95% confidence interval 1.00-1.33); P = 0.05]. Time to cessation of RRT through 28 days was longer in patients receiving higher intensity RRT (log-rank test P = 0.02) and when continuous renal replacement therapy was used as the initial modality of RRT (log-rank test P = 0.03). Conclusions: In severe AKI patients, higher intensity RRT does not affect mortality but appears to delay renal recovery. ",

keywords = "all-cause mortality, continuous RRT, intermittent RRT, renal recovery, renal replacement therapy dose intensity",

author = "Ying Wang and Martin Gallagher and Qiang Li and Serigne Lo and Alan Cass and Simon Finfer and John Myburgh and Catherine Bouman and Robert Faulhaber-Walter and Kellum, {John A.} and Palevsky, {Paul M.} and Claudio Ronco and Patrick Saudan and Ashita Tolwani and Rinaldo Bellomo",

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doi = "10.1093/ndt/gfx308",

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Wang, Y, Gallagher, M, Li, Q, Lo, S, Cass, A, Finfer, S, Myburgh, J, Bouman, C, Faulhaber-Walter, R, Kellum, JA, Palevsky, PM, Ronco, C, Saudan, P, Tolwani, A & Bellomo, R 2018, 'Renal replacement therapy intensity for acute kidney injury and recovery to dialysis independence: A systematic review and individual patient data meta-analysis', Nephrology Dialysis Transplantation, vol. 33, no. 6, pp. 1017-1024. https://doi.org/10.1093/ndt/gfx308

TY - JOUR

T1 - Renal replacement therapy intensity for acute kidney injury and recovery to dialysis independence

T2 - A systematic review and individual patient data meta-analysis

AU - Wang, Ying

AU - Gallagher, Martin

AU - Li, Qiang

AU - Lo, Serigne

AU - Cass, Alan

AU - Finfer, Simon

AU - Myburgh, John

AU - Bouman, Catherine

AU - Faulhaber-Walter, Robert

AU - Kellum, John A.

AU - Palevsky, Paul M.

AU - Ronco, Claudio

AU - Saudan, Patrick

AU - Tolwani, Ashita

AU - Bellomo, Rinaldo

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background: There is no consensus whether higher intensity dose renal replacement therapy (RRT) compared with standard intensity RRT has survival benefit and achieves better renal recovery in acute kidney injury (AKI). Methods: In an individual patient data meta-analysis, we merged individual patient data from randomized controlled trials (RCTs) comparing high with standard intensity RRT in intensive care unit patients with severe AKI. The primary outcome was all-cause mortality. The secondary outcome was renal recovery assessed as the proportion of patients who were RRT dependent at key trial endpoints and by time to the end of RRT dependence. Results: Of the eight prospective RCTs assessing different RRT intensities, seven contributed individual patient data (n = 3682) to the analysis. Mortality was similar between the two groups at 28 days [769/1884 (40.8%) and 744/1798 (41.4%), respectively; P = 0.40] after randomization. However, more participants assigned to higher intensity therapy remained RRT dependent at the most common key study point of 28 days [e.g. 292/983 (29.7%) versus 235/943 (24.9%); relative risk 1.15 (95% confidence interval 1.00-1.33); P = 0.05]. Time to cessation of RRT through 28 days was longer in patients receiving higher intensity RRT (log-rank test P = 0.02) and when continuous renal replacement therapy was used as the initial modality of RRT (log-rank test P = 0.03). Conclusions: In severe AKI patients, higher intensity RRT does not affect mortality but appears to delay renal recovery.

AB - Background: There is no consensus whether higher intensity dose renal replacement therapy (RRT) compared with standard intensity RRT has survival benefit and achieves better renal recovery in acute kidney injury (AKI). Methods: In an individual patient data meta-analysis, we merged individual patient data from randomized controlled trials (RCTs) comparing high with standard intensity RRT in intensive care unit patients with severe AKI. The primary outcome was all-cause mortality. The secondary outcome was renal recovery assessed as the proportion of patients who were RRT dependent at key trial endpoints and by time to the end of RRT dependence. Results: Of the eight prospective RCTs assessing different RRT intensities, seven contributed individual patient data (n = 3682) to the analysis. Mortality was similar between the two groups at 28 days [769/1884 (40.8%) and 744/1798 (41.4%), respectively; P = 0.40] after randomization. However, more participants assigned to higher intensity therapy remained RRT dependent at the most common key study point of 28 days [e.g. 292/983 (29.7%) versus 235/943 (24.9%); relative risk 1.15 (95% confidence interval 1.00-1.33); P = 0.05]. Time to cessation of RRT through 28 days was longer in patients receiving higher intensity RRT (log-rank test P = 0.02) and when continuous renal replacement therapy was used as the initial modality of RRT (log-rank test P = 0.03). Conclusions: In severe AKI patients, higher intensity RRT does not affect mortality but appears to delay renal recovery.

KW - all-cause mortality

KW - continuous RRT

KW - intermittent RRT

KW - renal recovery

KW - renal replacement therapy dose intensity

UR - http://www.scopus.com/inward/record.url?scp=85048642259&partnerID=8YFLogxK

U2 - 10.1093/ndt/gfx308

DO - 10.1093/ndt/gfx308

M3 - Article

C2 - 29186517

AN - SCOPUS:85048642259

SN - 0931-0509

VL - 33

SP - 1017

EP - 1024

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

IS - 6

ER -

Renal replacement therapy intensity for acute kidney injury and recovery to dialysis independence: A systematic review and individual patient data meta-analysis

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