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Intermittent versus continuous renal replacement therapy for acute renal failure in adults

  • Review
  • Intervention




Renal replacement therapy (RRT) for acute renal failure (ARF) can be applied intermittently (IRRT) or continuously (CRRT). It has been suggested that CRRT has several advantages over IRRT including better haemodynamic stability, lower mortality and higher renal recovery rates.


To compare CRRT with IRRT to establish if any of these techniques is superior to each other in patients with ARF.

Search methods

We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL). Authors of included studies were contacted, reference lists of identified studies and relevant narrative reviews were screened. Search date: October 2006.

Selection criteria

RCTs comparing CRRT with IRRT in adult patients with ARF and reporting prespecified outcomes of interest were included. Studies assessing CAPD were excluded.

Data collection and analysis

Two authors assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratios (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI).

Main results

We identified 15 studies (1550 patients). CRRT did not differ from IRRT with respect to in-hospital mortality (RR 1.01, 95% CI 0.92 to 1.12), ICU mortality (RR 1.06, 95% CI 0.90 to 1.26), number of surviving patients not requiring RRT (RR 0.99, 95% CI 0.92 to 1.07), haemodynamic instability (RR 0.48, 95% CI 0.10 to 2.28) or hypotension (RR 0.92, 95% CI 0.72 to 1.16) and need for escalation of pressor therapy (RR 0.53, 95% CI 0.26 to 1.08). Patients on CRRT were likely to have significantly higher mean arterial pressure (MAP) (MD 5.35, 95% CI 1.41 to 9.29) and higher risk of clotting dialysis filters (RR, 95% CI 8.50 CI 1.14 to 63.33).

Authors' conclusions

In patients who are haemodynamically stable, the RRT modality does not appear to influence important patient outcomes, and therefore the preference for CRRT over IRRT in such patients does not appear justified in the light of available evidence. CRRT was shown to achieve better haemodynamic parameters such as MAP. Future research should focus on factors such as the dose of dialysis and evaluation of newer promising hybrid technologies such as SLED. Triallists should follow the recommendations regarding clinical endpoints assessment in RCTs in ARF made by the Working Group of the Acute Dialysis Quality Initiative Working Group.








我們檢索MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) 。我們與被檢索的研究作者聯繫,篩選過其研究的參考書目。搜尋日期為2006年10月。




由兩位作者評估研究的質量和收集數據。統計分析要求隨機模型和其結果表現用相對危險度(RR),二分結果或平均差(加權平均數),為連續數據,有 95 %信賴區間(CI)的。


我們選定了15個研究(共1550例患者)。接受CRRT病患相較於IRRT患者,在醫院內死亡率(RR為1.01,95% CI為0.92至1.12),ICU死亡率(RR為1.06,95% CI為0.90至1.26),倖存且不需要RRT的病人(RR為0.99,95% CI為0.92至1.07),血流動力學不穩定(RR為0.48,95% CI為0.10至2.28)或低血壓(RR為0.92,95% CI為0.72至1.16)和需要升壓劑治療(為0.53, 95 % CI為0.26 1.08)的比例上並無顯著差異。病人對CRRT有顯著較高的平均動脈壓(MAP),(加權平均數為5.35, 95 % CI為1.41至9.29)和較高的透析過濾器凝固率(RR 8.50, 95 % CI為1.14至63.33)。


如果病人血液動力學穩定,任何RRT皆不影響患者的治療效果,因此若傾向於CRRT替代IRRT,在這類病人似乎沒有根據。不過CRRT的研究結果發現,它有更好的血流動力學狀態,如MAP。今後的研究重點應放在特別因素,如透析的劑量或其他的新技術,如兩種方式混合透析 (SLED, Sustained lowefficiency dialysis) 。研究者應遵循急性透析品質建議工作小組 (Acute Dialysis Quality Initiative Working Group) 的建議,在急性腎衰竭的研究上,依臨床狀況設定不同的實驗目標。



此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。


血液透析、血液過濾、血液透析過濾和無醋酸生物過濾都是體外腎臟替代療法,意即利用體外血液透析機清除廢物。有人認為,對流式的療法(像是血液過濾,血液透析過濾或是無醋酸生物過濾)可能可以減少透析期間和透析後發生不適的頻率和次數,並且比血液透析更能有效率地移除大分子量毒素。在本篇綜論,我們收集了20個研究(共657位病患),比較了血液透析與血液過濾,血液透析,無醋酸生物與血液透析 (17例); 血液透析過濾與無醋酸生物過濾 (2例); 血液過濾與血液透析過濾 (1例) 。結果發現對流式的療法比起血液透析,並不能改善死亡率、透析低血壓以及澱粉樣變性病。

Plain language summary

Intermittent versus continuous renal replacement therapy for acute renal failure in adults

Acute renal failure (ARF) is an abrupt reduction in kidney function with elevation of blood urea nitrogen (BUN) and plasma creatinine and a fall in urine output. In most cases correction of the underlying cause leads to recovery, however for many some form of renal replacement therapy (RRT - a treatment that removes waste products, salts and excess water form the body) may be required. RRT can either be intermittent (IRRT- performed for less than 24 hours in each 24 hour period, two to seven times per week) or continuous (CRRT- performed continuously without any interruption throughout each day). It has been suggested that CRRT has several advantages over IRRT including better haemodynamic stability (blood pressure control and blood circulation), improved survival and greater likelihood of renal recovery. Our systematic review identified 15 randomised studies with 1550 patients comparing CRRT with IRRT. We did not find any difference between CRRT and IRRT with respect to mortality, renal recovery, and risk of haemodynamic instability or hypotension episodes.

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