Efficacy of Continuous Renal Replacement Therapy and Intermittent Hemodialysis in Patients with Renal Failure in Intensive Care Unit: A Systemic Review and Meta-analysis
Table 1
Baseline characteristics of included studies.
Study
Study type
N
Age Sex (F%)
Disease
Design
Primary outcome
Secondary outcome
Risk
John, 2001, Germany
RCT
30
61 23%
ARF
IHD (lasting 3-4 h with blood flow rate 200-250 mL/min and dialysate flow rate 500 mL/min); n = 20 CVVH (18 mL/kg/h, and then 35 mL/kg/h) + Heparin; n = 10
In contrast to IHD, CVVH caused a decrease in heart rate (−3 (11) vs. 9 (8)/min, )) and an increase in systolic blood pressure (12 (1) vs. −5 (17) mmHg, ) after 2 h
After 24 h, increased systemic vascular resistance was found in the CVVH vs. IHD group (312 (755) vs. −29 (89) dyne/cm5, ) and there was a decrease in cardiac output (−1.54 (1.4) vs. −0.25 (0.91/min, )
L
Mehta, 2001, US
RCT
166
61 24%
ARF
IHD (flow rates of 500 mL/min, and blood flow rates of 200 to 300 mL/min, 2 sections, 3-4 h) + Heparin; n = 82 CAVHDF (blood flow rates of 100 mL/min, dialysate flow rates of 16.7 mL/min, and ultrafiltration rates of 400 to 800 mL/hour, >25 h) + Heparin; n = 84
The adjusted odds of death associated with CRRT was 1.58 (95% CI 0.7 to 3.3); overall, 36.6% patients (70.7% of those who survived) had a complete recovery of renal function, and there was no difference between the two groups (34.9% in CRRT vs. 33.3% in IHD, )
Days in ICU:(CRRT 15.1 vs. IHD 16.7 days, ). Days in hospital were significantly reduced for patients who received CRRT as the initial therapy only (CRRT 17.1 vs. IHD 26.3 days, )
M
Gasparovic, 2003, Croatia
RCT
104
NR
ARF
IHD (lasting 3-4 h with blood flow rate 200-250 mL/min and dialysate flow rate 500 mL/min); n = 52 CVVH (18–35 mL/kg/h) + Heparin; n = 52
In the IHD group, survivors are 21; in the CRRT group, survivors are 15. There was no difference in total survival rate between the two groups
There were no differences between the groups in extracorporeal procedure
H
Augustine, 2004, US
RCT
80
61 32%
ARF
IHD (3 treatments weekly using a blood flow rate of 300 mL/min and dialysate flow rate of 500 mL/min) + Heparin; n = 40 CVVH (a blood flow rate of 200 mL/min) + Heparin; n = 40
There were no differences in survival or renal recovery between the groups. In patients who died, mean survival time was 10.7 (11.2) days for the IHD group versus 14.3 (16.1) days for the CVVH group
Death occurred in 27 CVVH patients (67.5%) versus 28 IHD patients (70%; =NS). Five patients on CVVH had renal recovery versus 4 on IHD ()
M
Uehlinger, 2005, Switzerland
RCT
125
67 31%
ARF
IHD (blood flow ranged from 150 to 350 ml/min, lasted from 3 to 4 h); n = 55 CVVH (blood flow ranged from 100 to 180 ml/min + heparin); n = 70
Mortality rates in the hospital (47 vs. 51%, CVVH vs. IHD, ) or in the ICU (34 vs. 38%, ). The percentage of patients with full recovery of renal function was 50% in the CVVH and 42% in the IHD group ()
Hospital length of stay in the survivors on CVVH [20 (6-71) days] and in those on IHD [30 (2-89) days, ]. SCr: IHD 153 (59-496) vs. CVVH 121 (72-242) μmol/L
M
Noble, 2006, UK
RCT
117
53 29%
ARF
IHD (4 h daily with a cuprophane membrane and heparin); n = 53 CHDF (a biocompatible membrane and prostacyclin in addition to heparin, 30 h); n = 64
There was no difference in ICU mortality (73.5% [39/53] IHD vs. 71.8% [46/64] CHDF, ) or hospital mortality (83%[44/53] IHD vs. 76.5% [49/64] CHDF, ) between the two RRT treatment groups
SCr: IHD 412.5 (70-966) vs. CHDF 345 (70-2240) μmol/L; renal function at RRT initiation SCr: IHD 595 (260-1650) vs. CHDF 570 (200-2270)
M
Vinsonneau, 2006, France
RCT
360
65 27%
ARF
IHD (blood flow of 250 mL/min or more and dialysate flow set at 500 mL/min, 5.2 h); n = 184 CVVH (blood flow of 120 mL/min, dialysate flow of 500 mL/h, and ultrafiltration flow of 1000 mL/h); n = 175
Rate of survival at 60-days did not differ between the groups (32% in the intermittent hemodialysis group versus 33% in the continuous renal replacement therapy group (95% CI −8·8 to 11·1,), or at any other time
Days in ICU: IHD 20 (16-23) vs. CRRT 19 (15-22); days in hospital: 30 (24-35) vs. 32 (22-42) SCr: IHD 2.18 (1.8) vs. CVVH 2.12 (1.7) mg/dl
L
Lins, 2009, Belgium
RCT
316
66 41%
AKI
IRRT (4-6 h per session with a blood flow of 100-300 mL/min and a dialysate flow of 300-500 mL/min, 4 h); n = 144 CRRT (CVVH a blood flow rate of 100-250 mL/min and an ultrafiltration rate of 1-2 L/h, 4d) + anticoagulation; n = 172
A mortality of 62.5% in IRRT compared to 58.1% in CRRT. Days in ICU: 17.2 (18.7) vs. 18.7 (19.0); days in hospital: 31.4 (29.7) vs. 36.8 (31.0)
Mean SCr was 3.6 mg/dL in IRRT and 3.4 mg/dL in CRRT patients
M
Schefold, 2014, Germany
RCT
252
62 37%
ARF
IHD (4 hours of hemodialysis at a blood flow of 200 to 250 ml/min); n = 129 CVVH (24 hours daily by using a polysulfone synthetic membrane, blood flow of 200 ml/min); n = 123
Survival rates at 14 days after RRT were 39.5% (IHD) versus 43.9% (CVVH) (odds ratio (OR), 0.84; 95% CI, 0.49 to 1.41; ). 14 day-, 30-day, and all-cause intrahospital mortality rates were not different between the two groups
Days in ICU: IHD 25.2 (40.1) vs. CVVH 22.3 (26.1); days in hospital: 33.9 (49.3) vs. 32.4 (37.4) SCr: IHD 4.7 (0.8-10.9) vs. CVVH 3.9 (0.8-25.3) mg/dl
M
Dai, 2016, China
RCT
73
59 40%
AKI
IHD (blood flow of 150-200 mL/min or more and dialysate flow set at 500-1000 mL/min, 4 h) + heparin; n = 38 CVVH (blood flow of 150-200 mL/min and dialysate flow of 200-300 mL/h, 8-10 h) + heparin; n = 35
One week after treatment, compared to the IHD group, CRRT could dramatically reduce the levels of CRP (mg/L: 41.05 ± 10.15 vs. 60.21 ± 14.78, t = 6.401, ), SCr (μmol/L: 185.97 ± 65.48 vs. 232.02 ± 71.93, ), and urine output recovery time (days: 7.94 ± 3.06 vs. 11.08 ± 3.71, )
Length of ICU stay (days: 9.54 ± 3.39 vs. 13.42 ± 3.89, t = 4.521, ), organ support time (days: 3.23 ± 2.70 vs. 6.34 ± 3.36, t = 4.343, ), and the incidence of cardiovascular events (23.53% (8/35) vs. 39.47% (15/38), χ2 = 5.509, )
L
Hou, 2021, China
RCT
120
55 28%
AKI
IHD (blood flow of 220-250 mL/min and dialysate flow set at 500 mL/min, 6 h) + heparin; n = 60 CVVH (blood flow of 120-200 mL/min and dialysate flow of 25-45 mL/kg/h, 24 h) + heparin; n = 60
In the patients treated with CRRT, the levels of SCr, blood urea nitrogen, and blood lactic acid were all lower than those in the control group (all )
The time of staying in ICU, the period of oliguria, the time of renal replacement therapy, the time of staying in hospital, and the experimental group were all shorter than the control group (all )
