The dose of continuous renal replacement therapy for acute renal failure: a systematic review and meta-analysis

Figures & data

FIGURE 1. Flow chart of study selection.

TABLE 1.  Baseline characteristics of patients at the time of randomization

First author, year	Total no. of patients	Age (years; mean)	Male (%)	Weight (kg; mean)	Presence of CKD (%)	Most common cause of ARF	Illness score type	Average illness score	Presence of sepsis (%)	Serum creatinine (mg/dL)	Serum BUN (mg/dL)
Bouman,^10 2002	106	68	59	59	NR	Cardiac surgery	Apache 2	22.9	NR	NR	46 & 105
Boussekey,^17 2008	19	70	79	77	32	Sepsis	Apache 2	32.3	100	2.2	70
Network,^11 2008	1124	59.7	71	84	34	Ischemia	Apache 2	26	63	NR	66
Ronco,^7 2000	425	61	56	68	NR	Surgical	Apache 2	22.7	13	3.6	53
Saudan,^8 2006	206	63	61	73	33	Sepsis	Apache 2	25	60	4.9	83
Tolwani,^9 2008	200	60	58	91	42	Sepsis	Apache 2	26	54	4.3	75
Investigators RRTS,^12 2009	1465	64	65	80	32	NR	Apache 3	102	49	3.7	66

Notes: CKD, chronic kidney disease; ARF, acute renal failure; NR, not reported or unclear.

TABLE 2.  Study characteristics

First author, year	Total no. of patients	Modality	CRRT replacement fluid composition	Anticoagulation used	Prescribed low dosage (mL/kg/h)	Prescribed high dosage (mL/kg/h)	Delivered low dosage (mL/kg/h)	Delivered high dosage (mL/kg/h)	Primary outcome measure
Bouman,^10 2002	106	CVVHF	Bicarbonate	Heparin, nadroparin	NR	NR	20.1 and 19.1	48.2	Survival at day 28 and recovery of renal function
Boussekey,^17 2008	19	CVVHF	Bicarbonate	Heparin	35	65	32	62	Decrease of vasopressor dose along with a MAP>65 mmHg
Network,^11 2008	1124	CVVHDF	Bicarbonate	Citrate, heparin, or none	21.5	36.2	22	38.5	Duration of survival in ICU and renal recovery
		SLED		Heparin
				Citrate
		IHD
Ronco,^7 2000	425	CVVHF	Lactate	Heparin	20	35 and 45	NR	NR	Survival 15 days after discontinuation of treatment
Saudan,^8 2006	206	CVVHF	Lactate, bicarbonate	Heparin	25	42	NR	NR	Survival at 28 and 90 days
		CVVHDF
Tolwani,^9 2008	200	CVVHDF	NR	Citrate	20	35	17	29	Survival to ICU discharge or 30 days
Investigators RRTS,^12 2009	1465	CVVHDF	Bicarbonate	Heparin	25	40	22	33	Survival at 90 days

Notes: CVVHF, continuous venous to venous hemofiltration; CVVHD, continuous venous to venous hemodialysis; CVVHDF, continuous venous to venous hemodiafiltration; SLED, slow low-efficiency dialysis; IHD, intermittent hemodialysis; MAP, mean arterial pressure; NR, not reported or unclear.

TABLE 3.  Study quality

First author, year	Study design	Allocation concealment	Blinding				Funding	Lost to follow-up (%)
			Patients	Care givers	Outcome assessors	Data collectors
Bouman,^10 2002	Randomized	Yes	No	No	No	No	NR	NR
Boussekey,^17 2008	Randomized	No	No	No	No	No	Nonprofit	NR
Network,^11 2008	Randomized	Yes	NR	NR	Yes	No	Nonprofit	<1
Ronco,^7 2000	Randomized	NR	No	No	NR	NR	NR	0
Saudan,^8 2006	Randomized	Yes	No	No	No	No	NR	0
Tolwani,^9 2008	Randomized	Yes	No	No	No	No	Nonprofit/industry	0
Investigators RRTS,^12 2009	Randomized	Yes	No	No	NR	NR	Nonprofit	<1

Note: NR, not reported or unclear.

FIGURE 2. Risk of death.

FIGURE 3. Risk of long-term requirement of renal replacement therapy.

Bouman CS, Oudemans-Van Straaten HM, Tijssen JG, Zandstra DF, Kesecioglu J. Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: A prospective, randomized trial [see comment]. Crit Care Med. 2002;30:2205–2211.

 PubMed Web of Science ®Google Scholar

Boussekey N, Chiche A, Faure K, A pilot randomized study comparing high and low volume hemofiltration on vasopressor use in septic shock. Intensive Care Med. 2008;34:1–8.

 PubMed Web of Science ®Google Scholar

Network VNARFT, Palevsky PM, Zhang JH, Intensity of renal support in critically ill patients with acute kidney injury [see comment]. New Engl J Med. 2008;359:7–20.

 PubMed Web of Science ®Google Scholar

Ronco C, Bellomo R, Homel P, Effects of different doses in continuous veno-venous hemofiltration on outcomes of acute renal failure: A prospective randomised trial [see comment]. Lancet. 2000;356:26–30.

 PubMed Web of Science ®Google Scholar

Saudan P, Niederberger M, De Seigneux S, Adding a dialysis dose to continuous hemofiltration increases survival in patients with acute renal failure [see comment]. Kidney Int. 2006;70:1312–1317.

 PubMed Web of Science ®Google Scholar

Tolwani AJ, Campbell RC, Stofan BS, Lai KR, Oster RA, Wille KM. Standard versus high-dose CVVHDF for ICU-related acute renal failure [see comment]. J Am Soc Nephrol. 2008;19:1233–1238.

 PubMed Web of Science ®Google Scholar

Investigators RRTS, Bellomo R, Cass A, Intensity of continuous renal-replacement therapy in critically ill patients [see comment]. New Engl J Med. 2009;361:1627–1638.

 PubMed Web of Science ®Google Scholar