A Cochrane review included 6 studies with a total of 3 185 critically ill patients with acute kidney injury. There was no significant difference between intensive versus less intensive continuous renal replacement therapy (CRRT) on risk of mortality or recovery of kidney function ()..
A Cochrane review included 15 studies with a total of 1550 patients. Continuous renal replacement therapy (CRRT) did not differ from intermittent renal replacement therapy (IRRT) with respect to in-hospital mortality (RR 1.01, 95% CI 0.92 to 1.12, 7 studies, n=1245), intensive care unit mortality, number of surviving patients not requiring renal replacement therapy, haemodynamic instability or hypotension and need for escalation of pressor therapy. Patients on CRRT were likely to have higher mean arterial pressure (WMD 5.35, 95% CI 1.41 to 9.29) and higher risk of clotting dialysis filters (RR 8.50, CI 1.14 to 63.33, 3 trials, n=149).
| Outcome | Relative effect (95% CI) | Assumed risk - Control - Less intensive CRRT | Corresponding risk Intensive CRRT (95% CI) | No. of participants (studies) Quality of evidence |
|---|---|---|---|---|
| Mortality at day 30 | RR 0.88 (0.81 to 1.1) | 430 per 1000 | 420 per 1000 (412 to 523) | 2402 (5) Low |
| Mortality after 30 days Follow-up: 60 days | RR 0.92 (0.80 to 1.06) | 514 per 1000 | 483 per 1000 (416 to 565) | 2402 (5) Low |
| Patients free of renal replacement therapy after discontinuing CRRT Follow-up: 90 days | RR 0.98 (0.94 to 1.01) | 923 per 1000 | 904 per 1000 (867 to 932) | 988 (3) Moderate |
| Adverse events: hypophosphataemia | RR 1.21 (1.11 to 1.31) | 540 per 1000 | 654 per 1000 (600 to 708) | 1441 (1) High |
Comment: The costs for IRRT are much less than the costs for CRRT.