Vol. 20 No. 1 (2016)
ANESTHESIOLOGY & RESUSCITATION

Prolonged intermittent dialysis as an alternative to continuous renal replacement therapy in critically ill patients: a systematic review and meta-analysis

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  • Z. Unarokov,
  • A. Borisov,
  • T. Sokolnikova,
  • V. Lomivorotov
Z. Unarokov
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, 15 Rechkunovskaya St., 630055 Novosibirsk
A. Borisov
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, 15 Rechkunovskaya St., 630055 Novosibirsk
T. Sokolnikova
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, 15 Rechkunovskaya St., 630055 Novosibirsk
V. Lomivorotov
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, 15 Rechkunovskaya St., 630055 Novosibirsk
DOI: https://doi.org/10.21688/1681-3472-2016-1-25-34

Published 2016-03-25

Keywords

  • acute kidney injury,
  • renal replacement therapy,
  • mortality,
  • kidney function recovery,
  • fluid removal,
  • systematic search,
  • meta-analysis
    • ...More
    Less

How to Cite

Unarokov, Z., Borisov, A., Sokolnikova, T., & Lomivorotov, V. (2016). Prolonged intermittent dialysis as an alternative to continuous renal replacement therapy in critically ill patients: a systematic review and meta-analysis. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 20(1), 25–34. https://doi.org/10.21688/1681-3472-2016-1-25-34

Copyright (c) 2016 Unarokov Z. M., Borisov A. S., Sokolnikova T. A., Lomivorotov V. V.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Objective
The purpose of the study was to compare the impact of prolonged intermittent renal replacement therapy (PIRRT) and continuous renal replacement therapy (CRRT) on the outcomes of critically ill patients with acute kidney injury (AKI).
Methods
A systematic search for peer-reviewed papers published in PubMed, Scopus и Science Index and a meta-analysis of all randomized and cohort studies on CRRT/PIRRT comparison were carried out. In accordance with the mean points of patients obtained by APACHE II score (threshold of 27 points), all studies were stratified in two groups. The incidence of clinical outcomes such as mortality, length of stay in intensive care unit (ICU), recovery of kidney function and fluid removal were evaluated. The results were pooled using a random-effects model.
Results
We identified 19 studies from 2000 to August 2015, 7 of which were randomized and 12 considered as cohort ones. Group I (APACHE II<27) included 9 studies (n = 623), and Group II (APACHE II<27) had 10 studies (n = 1194). There were no significant differences in mortality rates, length of stay in ICU and duration of mechanical ventilation between the groups and dialytic modalities. However, pooled analyses in Group II tended towards a higher rate of recovery of kidney function among patients who received CRRT, as compared with PIRRT (RR 1.85 [95% CI 1.00-3.42], р = 0.05). Also, the volume of obtained ultrafiltration in Group II was higher in those patients who underwent CRRT as compared to those who received PIRRT (RR -0.21 [95% CI -0.36 … -0.05], р<0.01).
Conclusion
Based on current data, PIRRT and CRRT appear to have a similar mortality rate for patients with AKI. However, treatment with CRRT might be associated with lower rates of dialysis dependence and higher rate of fluid removal than PIRRT in critically ill patients.

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