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.

BACKGROUND

Net ultrafiltration (UF 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 UF 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 UF intensity and either mortality (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.68-1.21, p = 0.49, I = 84%) or renal recovery (OR = 0.96, 95% CI = 0.57-1.61, p = 0.87, I = 75%) among critically ill patients. However, a high intensity of UF was associated with lower mortality in patients with acute kidney injury (AKI) (OR = 0.73, 95% CI = 0.59-0.90, p = 0.004, I = 67%). Furthermore, the study revealed a noteworthy correlation between a high UF intensity and a longer length of hospital stay (weighted mean difference = 3.34 d, 95% CI = 2.64-4.03, p = 0%).

CONCLUSIONS

The association between UF intensity and mortality or renal recovery in critically ill patients is insufficient. However, a high UF intensity is associated with an increasing length of hospital stay among critically ill patients.