Sorry to miss the Saturday commitment for good publications.
The latest issue of Nephrology Dialysis and Transplantation published a meta analysis of intensity of RRT.
Renal replacement therapy intensity for acute kidney injury and recovery to dialysis independence: a systematic review and individual patient data meta-analysis
The common problem faced in intensive care is timing and intensity of renal replacement therapy. It is a popular concept that higher intensity of RRT leads to better outcomes and higher rates of dialysis independence. However, there is no consensus on whether higher intensity should be the norm.
Kellum et al carried out a meta analysis of eight high quality studies measuring high intensity RRT against 28 day mortality as primary end point. RRT independence was the secondary outcome of interest. Analysis of data from more than three thousand patients revealed no mortality benefit with intensive regimens of RRT. The analysis also revealed that patients who received intensive prescriptions of RRT remained dependent on dialysis at 28 days.
The reviewers concluded that Intensive RRT prescription confers no survival benefit among patients with severe AKI. On the other hand intensive RRT might prolong the liberation from RRT.
My opinion: We need to be careful while prescribing RRT in severe AKI. Prescribing intensive RRT based on clinical severity might not yield the desired results
Sir, do we need to change our practice of doing frequent sessions of or continous form of RRT targetting metabolic acidosis?
ReplyDeleteIs there any difference it made to vasopressor days sir?
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