1439: CHARACTERISTICS AND OUTCOME OF KIDNEY TRANSPLANT PATIENTS IN THE ICU A 10-YEAR SINGLE-CENTER STUDY

Abstract

Learning Objectives: Initial renal replacement therapy (RRT) modality may affect renal recovery in patients with acute kidney injury (AKI). The comparative effectiveness of each RRT modality on renal recovery in AKI is unclear. This study used network meta-analysis (NMA) to examine the effects of initial RRT modality on renal recovery in patients with AKI. ith AKI. Methods: Articles were identified by searching MEDLINE, EMBASE, CINAHL, and CENTRAL from inception to March 19, 2017. Included articles were randomized controlled trials (RCTs) that examined RRT modalities in adults (≥18 years) with AKI, and reported RRT independence at study end. Eligible RRT modalities included any method of intermittent renal replacement therapy (IRRT), prolonged intermittent renal replacement therapy (PIRRT), continuous renal replacement therapy (CRRT), and peritoneal dialysis (PD). The primary outcome, renal survival, was defined as alive and free of RRT at study end. Study quality was assessed using the Cochrane Collaboration’s Risk of Bias Tool for Intervention Studies. Random effects Bayesian NMA that incorporated informative priors around the random effects examined the effect of RRT modality on the primary outcome, reported as an odds ratio (OR) with 95% credible interval (95% CrI). Results: 19 RCTs and 2,643 patients were included in the NMA. Included RCTs were parallel group, two-arm trials. Of the 38 possible treatment groups, different methods of IRRT were assessed in 11 groups, PIRRT 7 groups, CRRT 13 groups, and PD 3 groups of patients. IRRT was mostly intermittent hemodialysis (IHD); PIRRT a mixture of slow low efficiency dialysis, extended daily dialysis, and sustained hemodiafiltration (SHDF); and CRRT a mixture of continuous venovenous hemodiafiltration (CVVHDF), continuous venovenous hemodialysis, and continuous venovenous hemofiltration. Renal survival, most commonly assessed at hospital discharge (9/19 RCTs), was 36% in the overall population. NMA suggested that a method of PIRRT, namely SHDF was associated with an increase in renal survival when compared to IHD (OR 4.13, 95% CrI 1.01-14.35) or CVVHDF (OR 3.01, 95% CrI 1.16-8.11). Quality of included studies was low-to-moderate. Conclusions: NMA suggests that PIRRT as initial RRT modality in patients with AKI may result in improved renal survival compared to more traditional methods such as IHD or CVVHDF. This finding requires confirmation in additional highquality RCTs.