Effect of sustained low efficient dialysis : A systematic review and meta‐analysisversus: A systematic review and meta‐analysis continuous renal replacement therapy on renal recovery after acute kidney injury in the intensive care unit: A systematic review and meta‐analysis

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Excerpt

Acute kidney injury (AKI) is a significant contributing factor to the morbidity and mortality of critically ill adults.1 There are various modalities of in‐hospital renal replacement therapies (RRT) that are in use today, but the critically ill patient imposes the additional challenge of serious haemodynamic instability, which limits RRT options. The advent of continuous RRT (CRRT) permitted the treatment of haemodynamically unstable AKI with tolerance for ultrafiltration, excellent control of azotemia and potentially less ongoing or repeated renal ischaemia. The introduction of sustained low‐efficiency dialysis (SLED), which utilizes lower flow rates than conventional intermittent haemodialysis (IHD), improves convenience by restricting therapy time while still allowing for a similar haemodynamic tolerability to CRRT. Additionally, SLED is operationalized with IHD equipment and does not require pre‐packaged replacement solution(s). Cost savings thus accrued has resulted in the promotion of SLED utilization in many centers.3 Nevertheless, there exists a lack of consensus regarding the optimal RRT modality for critically ill patients. Specifically, SLED has not been universally accepted in part because of lack of evidence for haemodynamic tolerability in specific populations with AKI and shock.4 It has been suggested that the haemodynamic stability‐associated CRRT compared with IHD may result in a higher renal recovery rate5; however, few data exist for a comparison of renal recovery with SLED.
We conducted a systematic review and meta‐analysis to determine the effect of the mode of dialysis (SLED vs CRRT) on the likelihood of renal recovery in critically ill adults. Our secondary outcomes were to determine the effect of SLED versus CRRT on time to renal recovery, haemodynamic stability/vasopressor use, hypotension and mortality.
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