Association of net ultrafiltration intensity and clinical outcomes among critically ill patients receiving continuous renal replacement therapy: A systematic review, meta-analysis, and trial sequential analysis
Lu Jin MBBS, Peiyun Li MM, Qing Xu MBBS, Fang Wang MD, Ling Zhang MD, PhD
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Abstract
Background
Net ultrafiltration (UFnet) has been used in the fluid management of critically ill patients undergoing continuous renal replacement therapy for an extended duration. Despite its widespread application, the correlation between UFnet intensity and clinical outcomes remains controversial.
Methods
Electronic databases (PubMed, Embase, Web of Science, and the Cochrane database) were searched from inception to November 30, 2023. All possible studies that examined the following outcomes were included: all-cause mortality, recovery of kidney function, and length of hospital stay.
Results
A total of 6209 patients from six cohort studies were included. There was no significant association observed between UFnet intensity and either mortality (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.68–1.21, p = 0.49, I2 = 84%) or renal recovery (OR = 0.96, 95% CI = 0.57–1.61, p = 0.87, I2 = 75%) among critically ill patients. However, a high intensity of UFnet was associated with lower mortality in patients with acute kidney injury (AKI) (OR = 0.73, 95% CI = 0.59–0.90, p = 0.004, I2 = 67%). Furthermore, the study revealed a noteworthy correlation between a high UFnet intensity and a longer length of hospital stay (weighted mean difference = 3.34 d, 95% CI = 2.64–4.03, p2 = 0%).
Conclusions
The association between UFnet intensity and mortality or renal recovery in critically ill patients is insufficient. However, a high UFnet intensity is associated with an increasing length of hospital stay among critically ill patients.
期刊介绍:
Australian Critical Care is the official journal of the Australian College of Critical Care Nurses (ACCCN). It is a bi-monthly peer-reviewed journal, providing clinically relevant research, reviews and articles of interest to the critical care community. Australian Critical Care publishes peer-reviewed scholarly papers that report research findings, research-based reviews, discussion papers and commentaries which are of interest to an international readership of critical care practitioners, educators, administrators and researchers. Interprofessional articles are welcomed.