• Ling Zhang, Jiqiao Yang, Glenn M Eastwood, Guijun Zhu, Aiko Tanaka, and Rinaldo Bellomo.
• Division of Nephrology, West China Hospital of Sichuan University, Sichuan, Chengdu, China; Division of Intensive Care Unit, Austin Health, Heidelberg, VIC, Australia.
• Am. J. Kidney Dis. 2015 Aug 1;66(2):322-30.

BackgroundExtended daily dialysis (EDD) has been suggested as an effective renal replacement therapy for acute kidney injury. However, results from studies comparing EDD to continuous renal replacement therapy (CRRT) are inconclusive.Study DesignA systematic review and meta-analysis was performed by searching in MEDLINE, EMBASE, the Cochrane Library, Google Scholar, and a Chinese database (SinsoMed).Setting & PopulationPatients with acute kidney injury.Selection Criteria For StudiesRandomized controlled trials (RCTs) and observational studies were included. EDD was defined as extended hemodialysis or hemodiafiltration for more than 6 but less than 24 hours per session using a conventional hemodialysis machine.InterventionRenal replacement therapy comparing EDD with CRRT.OutcomesMortality, kidney recovery, and fluid removal.ResultsWe included 17 studies from 2000 to 2014: 7 RCTs and 10 observational studies involving 533 and 675 patients, respectively. Meta-analysis of RCTs showed no difference in mortality rates between EDD and CRRT (relative risk, 0.90; 95% CI, 0.74-1.11; P=0.3). However, EDD was associated with lower mortality risk compared with CRRT in observational studies (relative risk, 0.86; 95% CI, 0.74-1.00; P=0.05). There was no evidence of heterogeneity in RCTs (I(2)=0%) or observational studies (I(2)=15%). In both RCTs and observational studies, there were no significant differences in recovery of kidney function, fluid removal, or days in the intensive care unit, and EDD showed similar biochemical efficacy to CRRT during treatment (serum urea, serum creatinine, and serum phosphate).LimitationsThe survival benefit of EDD is dependent on only observational studies and might have been affected by allocation or selection bias.ConclusionsEDD is associated with similar outcomes to CRRT in RCTs. The finding that EDD is associated with a lower mortality rate relies on data from observational studies, which are potentially subject to allocation or selection bias, making further high-quality RCTs desirable.Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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