Intensive- vs less-intensive-dose continuous renal replacement therapy for the intensive care unit–related acute kidney injury: A meta-analysis and systematic review

ObjectiveThe aim of the study is to summarize the effect of intensive-dose continuous renal replacement therapy (CRRT) on the mortality and other clinical outcomes.MethodsA 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.ResultsWe 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 (I2 = 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.ConclusionThis 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.