Table 1.
Characteristics of studies reporting the effects of RRT dose in patients with AKI
| Study | Inclusion Criteria | Treatment Group 1 | Treatment Group 2 | Control | Design | Number of Patients | Mean Age (years) | Male, n (%) | Primary Cause of AKI | Mean Creatinine (mg/dl) | Number of Mortality Events |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Ronco et al. (4) | AKI: abnormal concentration of serum BUN and creatinine; oliguria (despite fluid resuscitation and diuretics) | CVVH (45 ml/kg per h) | CVVH (35 ml/kg per h) | CVVH (20 ml/kg per h) | Randomized single-center | 425 | 61 | 238 (56%) | Surgery (89%) | 3.6 | 205 (48%) |
| Bouman et al. (11) | 18 to 90 years (inclusive); AKI: oliguria (despite fluid resuscitation); hemodynamic optimization with dopamine or dobutamine; use of phosphodiesterase inhibitors or norepinephrine, use of diuretics; creatinine clearance of <20 ml/min; mechanical ventilation | CVVH early-high-volume (48 ml/kg per h) | CVVH early-low-volume (25 ml/kg per h) | CVVH late-low-volume (25 ml/kg per h) | Randomized two-center | 106 | 68 | 63 (59%) | Cardio-surgery (58%) | NR | 29 (27%) |
| Schiffl et al. (5) | ≥18 years; AKI severe acute tubular necrosis caused by recent ischemic or nephrotoxic injury | Daily IHD (weekly Kt/V = 8.4) | – | Alternate-daily IHD (weekly Kt/V = 4.2) | Quasi-randomized single-center | 160 | 60 | 80 (55%)a | Hypotension (54%) | 4.7 | 59 (37%) |
| Saudan et al. (12) | AKI: oliguria (despite fluid resuscitation and diuretics) and/or azotemia with urine output <1500 ml/12 h | CVVHDF (42 ml/kg per h) | – | CVVH (25 ml/kg per h) | Randomized single-center | 206 | 63 | 125 (61%) | Sepsis (60%) | 5.6 | 110 (53%) |
| Tolwani et al. (13) | AKI: volume overload/oliguria (despite diuretics/fluid resuscitation); anuria; azotemia; hyperkalemia and/or increase in serum creatinine | CVVHDF (35 ml/kg per h) | – | CVVHDF (20 ml/kg per h) | Randomized single-center | 200 | 60 | 116 (58%) | Sepsis (54%) | 4.25 | 95 (48%) |
| ATN study (2) | ≥18 years; AKI: severe acute tubular necrosis and requiring RRT; failure of ≥1 nonrenal organ systems (defined by SOFA) or sepsis | IHD/CVVHDF or SLED 6×/wk (36.2 ml/kg per h) | – | IHD/CVVHDF or SLED 3×/wk (21.5 ml/kg per h) | Randomized multicenter | 1124 | 60 | 793 (71%) | Ischemia (81%) | NR | 591 (53%) |
| Faulhaber-Walter et al. (14) | Non-post-renal AKI with RRT dependence: >30% loss of kidney function; oliguria, anuria, hyperkalemia, or severe acidosis | Dose to maintain plasma urea levels 120 to 150 mg/dl (IHD) | – | Dose to maintain plasma urea levels <90 mg/dl (IHD) | Randomized single-center | 156 | 51 | 99 (64%) | SIRS/sepsis (72%)b | 3.1 | 65 (42%) |
| RENAL (3) | Non-post-renal AKI with RRT dependence: >30% loss of kidney function; oliguria, anuria, hyperkalemia, or severe acidosis | CVVHDF (40 ml/kg per h) | – | CVVHDF (25 ml/kg per h) | Randomized multicenter | 1464 | 65 | 946 (65%) | Sepsis (48%) | 3.8 | 654 (45%) |
BUN, blood urea nitrogen; CVVH, continuous venovenous hemofiltration; CVVHDF, continuous venovenous hemodiafiltration; SLED, sustained low-efficiency dialysis; NR, not reported.
a
Fourteen patients withdrew from the study; study has only reported baseline patient characteristics on 146 patients.
b
Study has reported “comorbidity at RRT initiation”; value represents the highest comorbidity; all dose values indicate prescribed doses.