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

Objectives: To conduct a systematic review of the literature to summarize the best available evidence regarding the mortality and morbidity associated with differing dosing regimens of continuous renal replacement therapy (CRRT) for patients with acute renal failure (ARF) in an intensive care unit setting. Patients and Methods: We searched for randomized controlled trials in electronic databases from January 1990 through November 2009. Eligible trials compared two or more dosing regimens of CRRT in patients with ARF. Two reviewers working independently determined trial eligibility and extracted descriptive, methodological, and outcome data. Random-effects meta-analysis was used to assess relative risks (RR) and weighted mean difference. The I-2-statistic was used to assess heterogeneity of treatment effect across trials. Results: Seven trials were eligible for meta-analysis. We found no reduction in mortality in patients who received higher doses of CRRT (RR 0.88, 95% CI 0.75-1.03, I-2 = 74%). There was no difference in the requirement of renal replacement therapy at the conclusion of the study period (RR 1.12, 95% CI 0.86-1.46, I-2 = 3%). The overall quality of evidence was downgraded because of imprecision and heterogeneity. Conclusion: Increased dosing of CRRT is not associated with a decrease in mortality of patients with ARF in an intensive care unit setting.