Zhongheng Zhang1, Xiao Xu, Hongyang Zhu. 1. Intensive Care Unit of Jinhua Central Hospital, Zhejiang 321000, China. zh_zhang1984@hotmail.com
Abstract
OBJECTIVE: The aim of the study is to summarize the effect of intensive-dose continuous renal replacement therapy (CRRT) on the mortality and other clinical outcomes. METHODS: A systematic search for randomized, controlled trials (RCTs) was performed. We estimated pooled relative ratios and 95% confidence intervals using fixed effects model or random effects model as appropriate. RESULTS: We analyzed data extracted from 6 RCTs comparing the effects of intensive and less intensive dose of RRT on clinical outcomes. A total of 3490 patients were included, including 1803 patients received intensive CRRT doses and 1687 received less-intensive doses. Overall, 44.5% (802/1803) patients died in the intensive dose group compared with 45.4% (766/1687) in the dose group, with the risk ratio of 0.91 (95% confidence interval: 0.77-1.08). The heterogeneity was remarkable (I(2) = 75%), and the subgroup analysis limited to patients with sepsis failed to find a reason for the heterogeneity. The intensive dose showed no beneficial effects on other clinical outcomes, and the complications associated with RRT were higher in the intensive dose group. CONCLUSION: This meta-analysis provides additional evidence that the higher dose of CRRT is not sufficient in reducing the mortality in critically ill patients with acute renal failure.
OBJECTIVE: The aim of the study is to summarize the effect of intensive-dose continuous renal replacement therapy (CRRT) on the mortality and other clinical outcomes. METHODS: A systematic search for randomized, controlled trials (RCTs) was performed. We estimated pooled relative ratios and 95% confidence intervals using fixed effects model or random effects model as appropriate. RESULTS: We analyzed data extracted from 6 RCTs comparing the effects of intensive and less intensive dose of RRT on clinical outcomes. A total of 3490 patients were included, including 1803 patients received intensive CRRT doses and 1687 received less-intensive doses. Overall, 44.5% (802/1803) patients died in the intensive dose group compared with 45.4% (766/1687) in the dose group, with the risk ratio of 0.91 (95% confidence interval: 0.77-1.08). The heterogeneity was remarkable (I(2) = 75%), and the subgroup analysis limited to patients with sepsis failed to find a reason for the heterogeneity. The intensive dose showed no beneficial effects on other clinical outcomes, and the complications associated with RRT were higher in the intensive dose group. CONCLUSION: This meta-analysis provides additional evidence that the higher dose of CRRT is not sufficient in reducing the mortality in critically illpatients with acute renal failure.