Continuous vs intermittent renal replacement therapy : mortality in critically ill patients with acute kidney injury

Abstract

Overview of the topic: Acute kidney injury (AKI) is defined as a decrease in renal function of sudden onset due to causes such as infection, physical trauma, inflammation, or toxicity (Mosby, 2016). AKI may necessitate the use of renal replacement therapies (RRT). In this dissertation, the aim was to identify if there is a difference in mortality in critically ill AKI patients treated with IHD and CRRT, respectively. The research question: In critically ill patients with acute kidney injury, how does intermittent haemodialysis compared with continuous renal replacement therapy affect mortality? PICO elements: The population (P) investigated consisted of critically ill patients with AKI. The intervention (I) observed was that of patients treated with CRRT. The compression was that of patients treated with IHD. The outcome (O) measured was mortality. Method: Alternative synonyms were utilized by creating synonyms from the keywords of the PICO question. The search was carried out using Boolean operators to combine the alternative synonyms. Limiters were applied to the search to decrease the quantity of irrelevant hits. Using the combined terms, the search was conducted in three databases: EBSCO, PubMed, and Scopus. Irrelevant articles were excluded using the PRISMA 2009 checklist. The eligibility of the studies was evaluated using an inclusion/exclusion criteria (Table 2.4). The inclusion criteria included published studies between 2010-2020, studies on adult intensive care patients and studies which included patient morality as a primary outcome. The exclusion criteria excluded literature that had a paediatric population, studies published in another language other than English and studies published before 2010. Finally, the key studies were critically appraised utilizing the Critical Appraisal Skills Programme (CASP) tool. Results: In this dissertation, six key studies were identified. The studies consisted of three meta-analyses and three retrospective cohort studies. Conclusion: From the results obtained, a definite conclusion cannot be obtained. Further research is required, regarding if one RRT has an advantage over the other in terms of decreasing patient’s mortality. Implications and recommendations: Further studies in this area of the PICO question are recommended to include patients with similar comorbidities and risk of in hospital mortality, for better comparison of RRT. It recommended that further continuing education is provided to healthcare professionals managing such therapies. Management is advised to issue and maintain appropriate guidelines regarding to utilization of RRT. Furthermore, the supply and maintenance of the renal modalities should be well taken care of, to ensure that this treatment option is always available for the patient. Recommendations for practice, include carrying out audits to improve nursing documentation and care of the patient treated with RRT.