Clinical review: Optimal dose of continuous renal replacement therapy in acute kidney injury

Table 1 Randomized controlled trials comparing dose of continuous renal replacement therapy in the intensive care unit

Study	Type	Number	Comparison	Survival (measured at)	Comment
RENAL [8] 2009	MC-RCT	1,508	40 mL/kg per hour versus	55% (day 90)
			25 mL/kg per hour	55% NS
			Post-dilution CVVHDF
ATN [4] 2008	MC-RCT	1,124	Pre-dilution CVVHDF 35 mL/kg per hour or 6/week SLEDD or 6/week IHD versus	46% (day 60)	Choice of CRRT/SLEDD versus IHD based on daily cardiovascular SOFA score.
			Pre-dilution CVVHDF 20 mL/kg per hour or 3/week SLEDD or 3/week IHD	48% NS
Tolwani, et al. [17] 2008	SS-RCT	200	17 mL/kg per hour	49% (ICU or 30 days)
			29 mL/kg per hour	56% NS
			Pre-dilution CVVHDF (delivered doses)
Saudan, et al. [15] 2006	SS-RCT	206	CVVHF: 1-2.5 L/hour versus	34% (day 90)
			CVVHDF: 1-2.5 L/hour HF + 1-1.5 L/hour HD	59% P = 0.0005
Bouman, et al. [18] 2002	2C-RCT	106	72-96 L/day early versus	74% (day 28)	Combined trial of dose and timing early versus late.
			24-36 L/day early versus	69% NS
			24-36 L/day late	75% NS
			CVVHF
Ronco, et al. [14] 2000	SS-RCT	425	20 mL/kg per hour versus	59% (day 15)	Unorthodox mortality outcome (day 15 after CRRT).
			35 mL/kg per hour versus	43%
			45 mL/kg per hour	42%
			Post-dilution CVVHF	20 versus 35 or 45
				P < 0.002
				35 versus 45 NS

2C-RCT, two-center randomized controlled trial; ATN, Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network; CRRT, continuous renal replacement therapy; CVVHDF, continuous veno-venous hemodiafiltration; CVVHF, continuous veno-venous hemofiltration; HD, hemodialysis; HF, hemofiltration; ICU, intensive care unit; IHD, intermittent hemodialysis; MC-RCT, multi-center randomized controlled trial; NS, not significant; RENAL, Randomized Evaluation of Normal versus Augmented Level; SOFA, Sequential Organ Failure Assessment; SLEDD, slow extended-duration daily dialysis; SS-RCT, single-center randomized controlled trial.

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