APPENDIX 1: CRRT versus IHD* - CADTH.ca removal is through convection CVVHF continuous venovenous...

Continuous Renal Replacement Therapy in Adult Patients with Acute Renal Failure: Systematic Review and Economic Evaluation

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APPENDIX 1: CRRT versus IHD* Table 1: Continuous Renal Replacement Nomenclature

Abbreviation Definition Description CAVHF continuous arteriovenous

hemofiltration driving force is patient’s blood pressure, circuit is arteriovenous, ultrafiltrate produced is replaced with replacement solution, ultrafiltration is excess of replacement results in patient volume loss, solute removal is through convection

CVVHF continuous venovenous hemofiltration

driving force is external pump, circuit is venovenous, other features similar to those of CAVHF

SCUF slow continuous ultrafiltration form of CAVHF or CVVHF not associated with fluid replacement, primary aim is to achieve fluid removal in fluid overloaded states

CAVHD continuous arteriovenous hemodialysis

driving force is patient’s blood pressure, circuit is arteriovenous, dialysate solution is delivered across membrane counter-current to blood flow at rate slower than blood flow rate, typical dialysate flow rates are 1 L/h to 2 L/h, fluid replacement is not routinely administered, solute removal is by diffusion

CVVHD continuous venovenous hemodialysis

driving force is external pump, circuit is venovenous, other features similar to those of CAVHD

CAVHDF continuous arteriovenous hemodiafiltration

driving force is patient’s blood pressure, circuit is arteriovenous, dialysate solution is delivered across membrane counter-current to blood flow at rate slower than blood flow rate, typical dialysate flow rates are 1 L/h to 2 L/h, ultrafiltration volumes optimized to exceed desired weight loss and enhance solute clearance from convection, fluid losses are replaced partly or completely with replacement solution, solute removal is diffusive and convective

CVVHDF continuous venovenous hemodiafiltration

driving force is external pump, circuit is venovenous, other features similar to those of CAVHDF

Table 2: Comparison of Intermittent versus Continuous Dialysis Therapies Continuous Renal Replacement Therapy (CRRT) Intermittent Hemodialysis (IHD)

Time 24 hours 4 to 6 hours Pump speed 100 to 180 mL/minute 200 to 500 mL/minute Dialysis membrane 0.9 m2 high flux 1.1 to 2.1 m2±high flux Dialysis flow rate 0 to 2 L/hour 500 to 750 mL/minute Replacement fluid 1 to 3 L/hour none Fluid removal +100 mL/hour to 500 mL/hour 500 to 1,000 mL/hour

* Pannu and Gibney, 2005.2


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APPENDIX 2: Search strategies Table 1: Literature Search Strategies

Database and Platform

Search Strategies Date of Search

Coverage of Search

MEDLINE ® (OVID)

1 [CRRT] 0 - 2 renal replacement therapy/ or renal dialysis/ or hemodiafiltration/ or hemofiltration/ 59022 3 (contin$ adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 8369 4 (CVVHD or CAVHD or CVVHDF or CAVHDF or CVVHF or CAVHF or CRRT or SCUF or CVVH or CAVH).tw. 899 5 or/2-4 64032 6 [IHD] 0 - 7 (intermittent adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 1316 8 ((Non-continu$ or noncontinu$ or discontinue$) adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 162 9 (IHD and (kidney or renal)).tw. 143 10 or/7-9 1555 11 5 or 10 64454 12 exp Kidney Failure, Acute/ 23298 13 (acute renal failure or acute kidney failure or ARF).tw. 16853 14 (acute renal insufficiency or acute kidney insufficiency).tw. 1196 15 acute tubular necrosis.tw. 1835 16 acute kidney tubular necrosis.tw. 1 17 ATN.tw. 616 18 or/12-17 30787 19 11 and 18 4962 20 RANDOMIZED CONTROLLED TRIAL.pt. 227233 21 CONTROLLED CLINICAL TRIAL.pt. 73582 22 RANDOMIZED CONTROLLED TRIALS/ 46059 23 RANDOM ALLOCATION/ 57572 24 DOUBLE BLIND METHOD/ 88623 25 SINGLE-BLIND METHOD/ 10243 26 or/20-25 385737 27 ANIMAL/ not HUMAN/ 3039204 28 26 not 27 363780 29 CLINICAL TRIAL.pt. 449329 30 exp CLINICAL TRIALS/ 189510 31 (clin$ adj25 trial$).ti,ab. 124558

27 June 2006 1966 to June Week 2 2006


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Table 1: Literature Search Strategies



Coverage of Search

32 ((singl$ or doubl$ or trebl$ or tripl$) adj25 (blind$ or mask$)).ti,ab. 87049 33 PLACEBOS/ 25242 34 placebo$.ti,ab. 97782 35 random$.ti,ab. 355789 36 RESEARCH DESIGN/ 44740 37 or/29-36 826007 38 37 not 27 768803 39 38 not 28 418958 40 COMPARATIVE STUDY/ 1313583 41 exp EVALUATION STUDIES/ 581443 42 FOLLOW UP STUDIES/ 330247 43 PROSPECTIVE STUDIES/ 211855 44 (control$ or prospectiv$ or volunteer$).ti,ab. 170182006 45 or/40-44 3378422 46 45 not 27 262006211 47 46 not (28 or 39) 220067576 48 28 or 39 or 47 2850314 49 19 and 48 1327

EMBASE ® (OVID)

1 [CRRT] 0 - 2 dialysis/ or hemodialysis/ or ultrafiltration/ 43854 3 (contin$ adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 6250 4 (CVVHD or CAVHD or CVVHDF or CAVHDF or CVVHF or CAVHF or CRRT or SCUF or CVVH or CAVH).tw. 799 5 or/2-4 47351 6 [IHD] 0 - 7 (intermittent adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 668 8 ((Non-continu$ or noncontinu$ or discontinue$) adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 121 9 (IHD and (kidney or renal)).tw. 121 10 or/7-9 856 11 5 or 10 47546 12 exp Acute Kidney Failure/ 9532 13 exp Acute kidney tubule necrosis/ 1303 14 (acute renal failure or acute kidney failure or ARF).tw. 11028 15 (acute renal insufficiency or acute kidney insufficiency).tw. 269

27 Jun 2006 1988 to 2006 Week 25


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Coverage of Search

16 (acute tubular necrosis or acute kidney tubular necrosis or ATN).tw. 1295 17 or/12-16 15566 18 11 and 17 3084 19 Randomized Controlled Trial/ 12006396 20 exp Randomization/ 19238 21 Double Blind Procedure/ 55547 22 Single Blind Procedure/ 5910 23 or/19-22 139925 24 Clinical Trial/ 379907 25 (clin$ adj25 trial$).mp. 437719 26 ((singl$ or doubl$ or trebl$ or tripl$) adj25 (blind$ or mask$)).mp. 85843 27 exp Placebo/ 62049 28 (placebo$ or random$).mp. 355546 29 exp Methodology/ 812564 30 exp Comparative Study/ 162583 31 exp Evaluation/ 4220068 32 exp Follow Up/ 186132 33 exp Prospective Study/ 55830 34 (control$ or prospectiv$ or volunteer$).mp. 2802130 35 or/24-34 3512529 36 23 or 35 3512529 37 limit 36 to human 2279318 38 Nonhuman/ 2255848 39 37 not 38 2030383 40 18 and 39 1199

Cochrane Database of Systematic Reviews (CDSR) (OVID)

1 dialysis/ or hemodialysis/ or ultrafiltration/ 2 (contin$ adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 3 (CVVHD or CAVHD or CVVHDF or CAVHDF or CVVHF or CAVHF or CRRT or SCUF or CVVH or CAVH).tw. 4 or/1-3 5 (intermittent adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 6 ((Non-continu$ or noncontinu$ or discontinue$) adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 7 (IHD and (kidney or renal)).tw. 8 renal replacement therapy/ 9 renal dialysis/ 10 hemodiafiltration/ 11 hemofiltration/

12 Jun 2006 1st Quarter 2006


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Coverage of Search

12 or/5-11 13 4 or 12 14 exp Kidney Failure, Acute/ 15 exp Acute kidney tubule necrosis/ 16 (acute renal failure$ or acute kidney failure$ or ARF).tw. 17 (acute renal insufficiency or acute kidney insufficiency).tw. 18 (acute tubular necrosis or acute kidney tubular necrosis or ATN).tw. 19 or/14-18 20 13 and 19

Database of Abstracts of Reviews of Effects (DARE) (OVID)

1 [dialysis/ or hemodialysis/ or ultrafiltration/] 0 - 2 (contin$ adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 8 3 (CVVHD or CAVHD or CVVHDF or CAVHDF or CVVHF or CAVHF or CRRT or SCUF or CVVH or CAVH).tw. 2 4 or/1-3 8 5 (intermittent adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 4 6 ((Non-continu$ or noncontinu$ or discontinue$) adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 0 - 7 (IHD and (kidney or renal)).tw. 2 8 [renal replacement therapy/] 0 - 9 [renal dialysis/] 0 - 10 [hemodiafiltration/] 0 - 11 [hemofiltration/] 0 - 12 or/5-11 5 13 4 or 12 10 14 [exp Kidney Failure, Acute/] 0 - 15 [exp Acute kidney tubule necrosis/] 0 - 16 (acute renal failure$ or acute kidney failure$ or ARF).tw. 11 17 (acute renal insufficiency or acute kidney insufficiency).tw. 1 18 (acute tubular necrosis or acute kidney tubular necrosis or ATN).tw. 1 19 or/14-18 13 20 13 and 19 3

12 Jun 2006

2nd Quarter 2006

Cochrane Central Register of Controlled Trials (CENTRAL) (OVID)

1 dialysis/ or hemodialysis/ or ultrafiltration/ 2046 2 (contin$ adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$

12 Jun 2006

2nd Quarter 2006


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Coverage of Search

or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 573 3 (CVVHD or CAVHD or CVVHDF or CAVHDF or CVVHF or CAVHF or CRRT or SCUF or CVVH or CAVH).tw. 80 4 or/1-3 2514 5 (intermittent adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 95 6 ((Non-continu$ or noncontinu$ or discontinue$) adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 6 7 (IHD and (kidney or renal)).tw. 16 8 renal replacement therapy/ 28 9 renal dialysis/ 1941 10 hemodiafiltration/ 87 11 hemofiltration/ 194 12 or/5-11 2204 13 4 or 12 2663 14 exp Kidney Failure, Acute/ 361 15 exp Acute kidney tubule necrosis/ 0 - 16 (acute renal failure$ or acute kidney failure$ or ARF).tw. 503 17 (acute renal insufficiency or acute kidney insufficiency).tw. 12 18 (acute tubular necrosis or acute kidney tubular necrosis or ATN).tw. 76 19 or/14-18 707 20 13 and 19 183

ProQuest Dissertations and Theses

CVVHD or CAVHD or CVVHDF or CAVHDF or CVVHF or CAVHF or CRRT or SCUF or CVVH or CAVH Intermittent hemodialysis Acute Kidney Failure Acute kidney tubule necrosis acute renal failure or acute kidney failure acute renal insufficiency or acute kidney insufficiency acute tubular necrosis or acute kidney tubular necrosis

11 Jun 2006 Not stated

SR Economic Evaluations Only Searches MEDLINE ® (OVID) 1 [CRRT] 0 -

2 renal replacement therapy/ or renal dialysis/ or hemodiafiltration/ or hemofiltration/ 59022 3 (contin$ adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 8369

29 Jul 2006


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Coverage of Search

4 (CVVHD or CAVHD or CVVHDF or CAVHDF or CVVHF or CAVHF or CRRT or SCUF or CVVH or CAVH).tw. 899 5 or/2-4 64032 6 [IHD] 0 - 7 (intermittent adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 1316 8 ((Non-continu$ or noncontinu$ or discontinue$) adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 162 9 (IHD and (kidney or renal)).tw. 143 10 or/7-9 1555 11 5 or 10 64454 12 exp Kidney Failure, Acute/ 23298 13 (acute renal failure or acute kidney failure or ARF).tw. 16853 14 (acute renal insufficiency or acute kidney insufficiency).tw. 1196 15 acute tubular necrosis.tw. 1835 16 acute kidney tubular necrosis.tw. 1 17 ATN.tw. 616 18 or/12-17 30787 19 11 and 18 4962 20 economics/ or value of life/ or economics, medical/ or economics, hospital/ or budgets/ or models, economic/ or markov chains/ or monte carlo method/ or decision trees/ or quality of life/ or patient satisfaction/ or quality-adjusted life years/ or economics.fs. 21 ((econom$ or cost or costly or costing or costed or price or prices or pricing or priced or discount or discounts or discounted or discounting or expenditure$ or budget$ or afford$ or pharmacoeconomic$ or pharmaco) adj1 economic$).tw. 22 (cost$ adj1 (util$ or effective$ or efficac$ or benefit$ or consequence$ or analy$ or minimi$ or saving$ or breakdown or lowering or estimate$ or variable$ or allocation or control or illness or sharing or life or lives or affordabl$ or instrument$ or technolog$ or day$ or fee or fees or charge or charges)).tw 23 (unit or drug or hospital or health care or medical adj1 (cost or costs)).tw 24 (markov or markow or monte carlo).tw 25 (decision adj1 (tree$ or analy$ or model$)).tw


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Coverage of Search

26 ((value or values or valuation) adj2 (money or monetary or life or lives)).tw. 27 (QOL or QOLY or QOLYs or HRQOL or QALY or QALYs).tw 28 ((quality adj1 life) or (willingness adj1 pay) or (quality adj1 adjusted life year$)).tw 29 or/20-28 30 19 and 29

EMBASE ® (OVID) 1 [CRRT] 0 - 2 dialysis/ or hemodialysis/ or ultrafiltration/ 43854 3 (contin$ adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 6250 4 (CVVHD or CAVHD or CVVHDF or CAVHDF or CVVHF or CAVHF or CRRT or SCUF or CVVH or CAVH).tw. 799 5 or/2-4 47351 6 [IHD] 0 - 7 (intermittent adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 668 8 ((Non-continu$ or noncontinu$ or discontinue$) adj4 (dialy$ or hemodia$ or haemodia$ or hemofiltr$ or haemofiltr$ or hemodiafilt$ or haemodiafilt$ or filtrat$ or renal replacement therap$ or ultrafiltr$ or arteriovenous$ or venovenous$)).tw. 121 9 (IHD and (kidney or renal)).tw. 121 10 or/7-9 856 11 5 or 10 47546 12 exp Acute Kidney Failure/ 9532 13 exp Acute kidney tubule necrosis/ 1303 14 (acute renal failure or acute kidney failure or ARF).tw. 11028 15 (acute renal insufficiency or acute kidney insufficiency).tw. 269 16 (acute tubular necrosis or acute kidney tubular necrosis or ATN).tw. 1295 17 or/12-16 15566 18 11 and 17 3084 19 Health economics/ OR economic evaluation/ OR pharmacoeconomics/ OR pharmacoeconomics.fs OR economic aspect/ OR quality adjusted life year/ OR quality of life/ 20 18 and 19

29 Jul 2006

Grey Literature Searches Agency for Healthcare Research and Quality

Renal replacement therap* (0), renal replacement (0), renal therapy (0), RRT(0), dialysis (1), hemodialysis

14 Jun 2006

1990-2006 (three assessments


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Coverage of Search

(1), haemodialysis (0), HD (0), renal dialysis(0), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), HF(0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0),continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0),IHD (0)

available for 2006)

Canadian Agency for Drugs and Technologies in Health

Renal (3), RRT(0), dialysis (2, redundant), hemodialysis (1, redundant), kidney (0) haemodialysis (0), extracorporeal (0), hemofiltration (0), haemofiltration (0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0), continuous (0), intermittent (0), CVVHD (0), CAVHD (), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0),IHD (0)

14 Jun 2006

site updated June 6, 2006

Centre for Clinical Effectiveness (Monash University)

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT(0), dialysis (2), hemodialysis (0), haemodialysis (2, redundant), HD (0), renal dialysis(0), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (1), HF(0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0), continuous(0), arteriovenous (0), venovenous (0), intermittent (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0), IHD (0), kidney (0), renal (0).

14 Jun 2006

1998-Feb 2005

Centre for Evaluation of Medicines

Renal replacement therap* (0), renal replacement (0), renal therapy (0), RRT(0), dialysis (1), hemodialysis (0), haemodialysis (0), HD (0), renal dialysis (0), extracorporeal (0), hemofiltration (0), haemofiltration (0), HF(0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0), continuous (0), arteriovenous (0), venovenous (0), intermittent (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0), IHD (0) kidney (0), renal (1, redundant).

14 Jun 2006

Projects and publications (1993-2005); presentations (Mar 27, 2006)

Centre for Health Economics and Policy Analysis (CHEPA)

Renal replacement therap* (0), renal replacement (0), renal therapy (0), RRT (0), dialysis (1), hemodialysis (1, redundant), haemodialysis (0), HD (0), renal dialysis (0), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), HF(0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0), continuous (0), arteriovenous (0), venovenous (0), intermittent (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0), IHD

14 Jun 2006

Publications (1999-2003); Working Papers (1998-Jan 2006), health policy commentaries (1991-1999)


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Coverage of Search

(0), kidney (0), renal (0) Centre for Health Services and Policy Research, University of British Columbia

Renal replacement therap* (0), renal replacement (0), renal therapy (0), RRT(0), dialysis (0), hemodialysis (0), haemodialysis (0), HD (0), renal dialysis(0), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), HF(0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0), continuous (0), arteriovenous (0), venovenous (0), intermittent (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (), SCUF (0), CVVH (0), CAVH (0), IRRT (0), IHD (0)

14 Jun 2006

BCOHTA publications (1991-2002); CHSPR reports 2003-2005

CenterWatch Clinical Trials Listing Service

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT(0), renal dialysis(0), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), HF(), hemodiafiltration (0), haemodiafiltration (), HDF (), ultrafiltration (0), continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0), IHD (0)

15 Jun 2006

site copyright 1995-2006

Clinical Trials Database (U.S. National Institutes of Health)

Renal replacement therapy AND (kidney disease) [CONDITION] (12) RRT AND (kidney disease) [CONDITION] (2, 1 redundant) continuous renal replacement AND (kidney disease) [CONDITION] (5, 4 redundant) intermittent hemodialysis AND (kidney disease) [CONDITION] (3) intermittent haemodialysis AND (kidney disease) [CONDITION] (redundant results); IHD AND (kidney disease) [CONDITION] (1) renal dialysis [ALL-FIELDS] AND (renal failure AND acute ) [CONDITION] (13); extracorporeal dialysis AND ( renal failure AND acute ) [CONDITION] (0); hemofiltration [ALL-FIELDS] AND (renal failure AND acute ) [CONDITION] (6, 5 redundant); haemofiltration [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (redundant results) hemodiafiltration [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (redundant results) haemodiafiltration [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (redundant results) HDF [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (0) ultrafiltration [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (0); continuous [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (redundant)

14 Jun 2006

contains approx 29,500 clinical studies sponsored by NIH, other federal agencies, and private industry


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Coverage of Search

arteriovenous [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (0) venovenous [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (redundant) intermittent [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (redundant) CVVHD [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (0) CAVHD [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (0) CVVHDF [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (0) CAVHDF [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (0) CVVHF [ALL-FIELDS] AND ( renal failure AND acute) [CONDITION] (0) CAVHF [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (0) CRRT [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (redundant) SCUF [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (0) CVVH [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (redundant) CAVH [ALL-FIELDS] AND ( renal failure AND acute ) [CONDITION] (0) IRRT [ALL-FIELDS] AND ( renal failure AND Acute) [CONDITION] (redundant)

Current Controlled Trials, metaRegister of Controlled Trials

Renal replacement therapy AND “renal failure” AND acute (4) renal replacement AND “renal failure” AND acute (redundant), renal therapy AND “renal failure” AND acute (0), RRT AND “renal failure” AND acute (0), renal dialysis AND “renal failure” AND acute (0), extracorporeal dialysis AND “renal failure” AND acute (0), hemofiltration AND “renal failure” AND acute (1), haemofiltration AND “renal failure” AND acute (0), HF AND “renal failure” AND acute (0), hemodiafiltration AND “renal failure” AND acute (0), haemodiafiltration AND “renal failure” AND acute (0), HDF AND “renal failure” AND acute (0), ultrafiltration AND “renal failure” AND acute (0), continuous arteriovenous AND “renal failure” AND acute (0), continuous AND “renal failure” AND acute (3, 2 redundant); continuous enovenous AND “renal failure” AND acute (2 redundant), intermittent arteriovenous AND “renal failure” AND acute (0),

14 Jun 2006

11 sources searched together


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Coverage of Search

intermittent venovenous AND “renal failure” AND acute (0), CVVHD AND “renal failure” AND acute (1 redundant), CAVHD AND “renal failure” AND acute (0), CVVHDF AND “renal failure” AND acute (0), CAVHDF AND “renal failure” AND acute (0), CVVHF AND “renal failure” AND acute (0), CAVHF AND “renal failure” AND acute (0), SCUF AND “renal failure” AND acute (0), CAVH AND “renal failure” AND acute (0), IRRT AND “renal failure” AND acute (0), IHD AND “renal failure” AND acute (0) CRRT AND acute (2); CVVH AND acute (1);

Directory of Open Access Journals

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT(0), renal dialysis(3), extracorporeal dialysis (0), hemofiltration (2), haemofiltration (0), HF(0), hemodiafiltration (2), haemodiafiltration (0), HDF (0), ultrafiltration (1), continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (), CVVH (0), CAVH (0), IRRT (0), IHD (0)

15 Jun 2006

site dated 2006

European Information Network on New and Changing Health Technologies

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT (0), renal dialysis(0), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), HF(0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0),continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0), IHD 0)

15 Jun 2006

dates not given

CMT – Center for Medical Technology Assessment

RRT (0), extracorporeal (0), hemofiltration (0), haemofiltration (0), HF (0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0), continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (), CVVH (0), CAVH (0), IRRT (0), IHD (0)

15 Jun 2006

Last updated Nov 2005

FDA – entire site

1. "Renal replacement therapy" AND "renal failure"' in All of the FDA 2. "CRRT" AND "renal failure"' in All of the FDA 3. "hemofiltration" AND "renal failure"' in All of the FDA 4. "hemodiafiltration" AND "renal failure"' in All of the FDA

15 Jun 2006

see for coverage: http://www.fda.gov/advsearch.html


A-13




Coverage of Search

5. "renal dialysis" AND "renal failure"' in All of the FDA 6. "ultrafiltration" AND "renal failure"' in All of the FDA 7. "continuous arteriovenous " AND "renal failure" 8. "continuous venovenous " AND "renal failure"' in All of the FDA 9. "CVVHD" AND "renal failure"' in All of the FDA 10. "CAVHD" AND "renal failure"' in All of the FDA 11. "SCUF" AND "renal failure"' in All of the FDA 12. "CVVH" AND "renal failure"' in All of the FDA (8)

Health Canada

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT (0), renal dialysis(0, too general), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0), continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0), IHD (0)

15 Jun 2006

searched 'Health Canada Online'

Health Economics Research Group (HERG)

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT (0), renal dialysis (0), extracorporeal dialysis (), hemofiltration (0), haemofiltration (0), HF (0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0), continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0), CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0), IHD (0)

15 Jun 2006

External 1985-1995, External 1996-current, HTAs, HERG Reports, Payback Publications, and PACS publications

Health Economics Research Unit (HERU), University of Aberdeen

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT (0), renal dialysis (0), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), HF (0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0), continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0), CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH 0), CAVH (0), IRRT (0), IHD (0) Hemodialysis (1); haemodialysis (4)

15 Jun 2006

Publications in Refereed Journals (1995-forthcoming) HERU Non-Refereed Publications (1995-2005) Books and book chapters (1996-forthcoming) HERU Discussion Papers (1994-2002) Briefing papers (1999-2006) HERU Presentations (1995-2005) HERU Reports (1995-2005)


A-14




Coverage of Search

Health Technology Assessment International (HTAi)

****Search engine unavailable at the time of the report.

International Network of Agencies for Health Technology Assessment

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT(0), renal dialysis(0), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), HF(0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0), continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0), IHD (0)

15 Jun 2006 INAHTA Publications

Institute for Clinical Evaluative Sciences (ICES)

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT (0), renal dialysis(), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), HF(), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0), continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0), IHD (0)

16 Jun 2006 Journal article abstracts (1998-2006); also searched by topic

ITA – Institute of Technology Assessment

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT (0), renal dialysis(0), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), HF(0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0), continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0), IHD (0), intermittent hemodialysis (0)

16 Jun 2006 Early 1990s and extends to 2006, search limited to English

Manitoba Centre for Health Policy (MCHP)

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT (0), renal dialysis (0), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), HF(0), hemodiafiltration 0), haemodiafiltration (0), HDF (0), ultrafiltration (0),continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0), IHD (0)

16 Jun 2006 report summaries (1994-2005), special supplements (2002,2005), papers published (1984-2006), papers presented (1997-2006), MCHP workshops and special visits (1999-2006)

Medicines and Healthcare Products Regulatory Agency

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT (0), renal dialysis (0), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), hemodiafiltration (0),

16 Jun 2006 "all document types"


A-15




Coverage of Search

haemodiafiltration (0), HDF (0), ultrafiltration (0), continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0), CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0),IHD (0)

National Horizon Scanning Centre (NHSC)

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT (0), renal dialysis (8), extracorporeal dialysis (0), hemofiltration (1), haemofiltration (0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0), continuous arteriovenous (), continuous venovenous (1, redundant), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0)

16 Jun 2006 searched entire site

National Research Register, U.K. Department of Health

The following searches include: ((acute NEXT renal NEXT failure) AND search term) (acute NEXT renal NEXT failure) AND Renal replacement therapy (3), (acute NEXT renal NEXT failure) AND renal replacement (3 redundant), (acute NEXT renal NEXT failure) AND renal therapy (0), (acute NEXT renal NEXT failure) AND renal dialysis (0) (acute NEXT renal NEXT failure) AND hemodia* OR haemodia* (1), (acute NEXT renal NEXT failure) AND hemofiltr* or haemofiltr* (0), (acute NEXT renal NEXT failure) AND hemodiafilt* (0), (acute NEXT renal NEXT failure) AND haemodiafilt* (0), (acute NEXT renal NEXT failure) AND ultrafiltr* (0), (acute NEXT renal NEXT failure) AND RRT(1), (acute NEXT renal NEXT failure) AND CVVHD (0), (acute NEXT renal NEXT failure) AND CAVHD (0), (acute NEXT renal NEXT failure) AND CVVHDF (0), (acute NEXT renal NEXT failure) AND CAVHDF (0), (acute NEXT renal NEXT failure) AND CVVHF (0), (acute NEXT renal NEXT failure) AND CAVHF (0), (acute NEXT renal NEXT failure) AND CRRT (0), (acute NEXT renal NEXT failure) AND SCUF (), (acute NEXT renal NEXT failure) AND CVVH (0), (acute NEXT renal NEXT failure) AND CAVH (0), (acute NEXT renal NEXT failure) AND IRRT (0), (acute NEXT renal NEXT failure) AND IHD (0) continuous renal replacement (4), extracorporeal

17 Jun 2006 provides a "reasonable record" of projects ongoing from early 2000, but some records from earlier in the 1990s


A-16




Coverage of Search

dialysis (0), continuous arteriovenous (0), continuous venovenous (2), intermittent arteriovenous (0), intermittent venovenous (0)

New Zealand HTA Clearing House for Health Outcomes and HTA

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT (0), renal dialysis(0), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0),continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), intermittent hemodialysis (0) CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (), CAVH (0), IRRT (0), IHD (0)

17 Jun 2006 1997-2005

NHS Health Technology Assessment /National Coordinating Centre for Health Technology Assessment (NCCHTA)

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT (0), renal dialysis (0), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), hemodiafiltration (0), haemodiafiltration (0), ultrafiltration (0), continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0), IHD (0)

17 Jun 2006 Site updated June 2006

NHS National Institute for Clinical Excellence (NICE)

RRT (0), hemodialysis (0), haemodialysis (1), HD (0), extracorporeal (0), hemofiltration (0), haemofiltration (0), HF(0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0), continuous (0), arteriovenous (0), venovenous (0), intermittent (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0),IHD (0)

18 Jun 2006 1999-2006

NLM Gateway

Continuous renal replacement therapy (12), "intermittent hemodialysis" (3), "acute renal failure" AND "renal dialysis" (8), extracorporeal dialysis (5, 4 redundant), ("acute renal failure" AND hemofiltration) OR ("acute renal failure" AND haemofiltration ) (9, 4 redundant), ("acute renal failure" AND hemodiafiltration) OR ("acute renal failure" AND haemodiafiltration) (2 redundant), "acute renal failure" AND ultrafiltration (0), “continuous arteriovenous” (0), “continuous venovenous” (7, 6 redundant), “intermittent arteriovenous” (0), “intermittent venovenous” (0), CVVHD (1 redundant), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (3 redundant), SCUF (0), CVVH (5 redundant), CAVH (0), IRRT (1 redundant), IHD (0)

18 Jun 2006 searched “meeting abstracts” and ClinicalTrials. gov

Ontario Ministry of Health and Long-Term

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT(0), renal dialysis(0),

18 Jun 2006 2001-2006


A-17




Coverage of Search

Care, Health Technology Reviews

extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), HF(0), hemodiafiltration (), haemodiafiltration (0), HDF (0), ultrafiltration (0),continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0), IHD (0)

Swedish Council on Technology Assessment in Health Care (SBU)

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT (0), renal dialysis (0), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), hemodiafiltration (1), haemodiafiltration (0), HDF 0), ultrafiltration (0), continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0), CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0), IHD (0)

18 Jun 2006 Searched ‘reports’

Technology Assessment Unit of the McGill University Health Centre

Renal replacement therap* (0), renal replacement (0), renal therapy (0), RRT (0), renal dialysis(0), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (), HF(0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0),continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0),IHD (0)

18 Jun 2006 Publications and works in progress”

Therapeutics Initiative, Evidence-Based Drug Therapy, University of British Columbia.

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT(0), renal dialysis(0), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0),continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0), CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF 0), CVVH (0), CAVH (0), IRRT 0), IHD (0)

18 Jun 2006 Entire site

University of Connecticut, Department of Economics

Renal replacement therap* (0), renal replacement (0), renal therapy (0), RRT (), renal dialysis(), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0), continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0), IHD (0)

18 Jun 2006 Not stated


A-18




Coverage of Search

Wessex Institute for Health Research and Development

Renal replacement therapy (0), renal replacement (0), renal therapy (0), RRT(0), renal dialysis(0), extracorporeal dialysis (0), hemofiltration (0), haemofiltration (0), hemodiafiltration (0), haemodiafiltration (0), HDF (0), ultrafiltration (0), continuous arteriovenous (0), continuous venovenous (0), intermittent arteriovenous (0), intermittent venovenous (0), CVVHD (0), CAVHD (0), CVVHDF (0), CAVHDF (0), CVVHF (0), CAVHF (0), CRRT (0), SCUF (0), CVVH (0), CAVH (0), IRRT (0), IHD (0)

19 Jun 2006 2004, 2005

West Midlands Health Technology Assessment Collaboration

This is part of the Department of Public Health and Epidemiology, University of Birmingham, as is The National Horizon Scanning Centre (NHSC). ***This source was therefore searched previously; results can be found under NHSC search results.

19 Jun 2006 See National Horizon Scanning Centre for results

NHS Economic Evaluation Database

Renal replacement therapy (0), renal replacement (0), renal therapy (0), CRRT (3), RRT AND renal AND failure (3), intermittent dialysis (0), intermittent hemodialysis (0), extracorporeal dialysis (0), (hemofiltration OR haemofiltration) AND “acute renal failure” (10), hemodiafiltration OR haemodiafiltration AND “acute renal failure” (10, 4 redundant), ultrafiltration (3, 1 redundant), “continuous arteriovenous” (0), “continuous venovenous” (0), “intermittent arteriovenous” (0), “intermittent venovenous” (0), CVVHD (0), CAVHD (0), CVVHDF (0),CAVHDF (0), CVVHF (0), CAVHF (0), SCUF AND “acute renal failure” (0), CVVH (0), CAVH (0), IRRT (1 redundant), IHD AND renal (3, 1 redundant)

19 Jun 2006 newest records May 2006

Table 2: List of Manufacturers Contacted

1. Baxter Healthcare Corporation 2. Bellco SRL 3. Fresenius USA, Inc. 4. Gambro Dasco SPA 5. Gambro Industries 6. Secon Zweigniederlassung Gambro Dialysatoren GmbH & Co. 7. B. Braun Medizintechologie


A-19

APPENDIX 3: Systematic Review Table 1: Characteristics of Included Studies – Submodality Comparisons

Author Country, Setting

Design Objective Sample

size

CRRT description

IHD or PD description

Population Population illness

severity

Technique Device

Membrane material

Flux

Buffer Anti-

coagulant

Dose Technique Device

Membrane material

Flux

Buffer Anti-coagulant Schedule

Dose Mean age % male

SCr µmol/L % on

pressors

Mean APACHE II

% SIRS % liver failure

Daud50 Malaysia ICU or coronary care unit

RCT Comparing techniques

20

CVVHD/ CVVHF Prisma PAN High

B H

2.0/1.7 L/h 28.5 mL/h

NR NR NR NR

NR NR NR

NR NR

50 60

259 NR

NR 90 0

Saudan, 200653 Switzerland ICU


206

CVVHDF/ CVVHF Prisma PAN High

L/B NR

25/24 mL/kg

/h URR 40/

50%

NR NR NR NR

NR NR NR

NR NR

63 61

428 >0

25 60 NR

Morgera45 Germany NR


and Qd 24

CVVHD/ CVVHF BM25

PA High

B H

1/2.5 L/h NR

NR NR NR NR

NR NR NR

NR NR

65 58

255 NR

32 100 NR

Sugahara52 Japan NR

RCT Comparing

dialysis initiation

28

CVVHD KM8600

PAN/PMMA High

L NR

1 L/h NR

NR NR NR NR

NR NR NR

NR NR

65 64

262 NR

19 NR NR

Brause51 Germany ICU

CCT Comparing

doses 70

CVVHF ADM 08

PS High

L H

1/1.5 L/h

Aver-age

BUN

NR NR NR NR

NR NR NR

NR NR

54 50

262 NR

APACHE III 70 50 NR


A-20

Table 1: Characteristics of Included Studies – Submodality Comparisons Author Country, Setting


size

CRRT description



severity

Technique Device

Membrane material

Flux

Buffer Anti-

coagulant


Membrane material

Flux



SCr µmol/L % on

pressors

Mean APACHE II


70/50 mg/dL

Bouman46 Netherlands ICU

RCT Comparing

time of dialysis

initiation and Qd

106

CVVHF Diapact/ Haemo-

processor CTA High

B H/N/none

NR 48/20/

19 mL/kg

/h

NR NR NR NR

NR NR NR

NR NR

68 59

CrCl 6 mL/min

>0

23 NR NR

Phu57 Vietnam ICU


70

CVVHF BMM 10-1/BS

1 PS

High

L H

2.0 L/h NR

PD NR NR NR

A H

NR

NR NR

36 81

558 NR

NR 31 NR

Schiffl54 Germany ICU

qRCT Comparing

schedule 160

NR NR NR NR

NR NR

NR NR

IHD MTS2008C

PS/PAN High

B H/none

alternative/ daily

Kt/V 3.6/wk

NR

60 55

420 NR

APACHE III 87 36 NR

Pettila55 Finland ICU


39

NR NR NR NR

NR NR

NR NR

IHDF/IHD AK 100 Ultra

PA High

B E

3 h/1st session, 4

h/other sessions

NR 164/128 L dialysate

and 4/40 L ultrafil-tration/ session

URR 39.8/ 39.9%

48 82

449 NR

20 79 NR


A-21



size

CRRT description



severity

Technique Device

Membrane material

Flux

Buffer Anti-

coagulant


Membrane material

Flux



SCr µmol/L % on

pressors

Mean APACHE II


Barenbrock47 Germany ICU

RCT Comparing

buffers 117

CVVHF NR NR NR

B/L H

1 L/h NR

NR NR NR NR

NR NR NR

NR NR

61 74

314 NR

26 45 NR

Ronco12 Italy ICU

RCT Comparing

doses 425

CVVHF Variable

PS NR

L H

NR 20/35/

45 mL/kg

/h

NR NR NR NR

NR NR NR

NR NR

61 56

318 NR

23 12 NR

Heering48 Germany ICU

CCT Comparing

buffers 132

CVVHF BSM 22

PS High

L/A/B H/none

1 L/h NR

NR NR NR NR

NR NR NR

NR NR

60 67

252 NR

22 43 NR

Nand58 India Renal unit


30

NR NR NR NR

NR NR

NR NR

PD/IHD NR/Drake

Willock machine NR NR

NR NR NR

NR NR

34 53 34 NR

NR NR NR

Storck49 Germany ICU


(pump-driven)

116

CAVHF/ CVVHF

NR/AK 10 PA/PS

Low/high

NR H

0.3/0.7 L/h NR

NR NR NR NR

NR NR NR

NR NR

58 NR 437 NR

NR NR NR

Gillum56 US Renal unit


NR NR NR

NR NR

NR NR

IHD Century II (Cobe)

C

NR NR

as required to

NR target pre-

dialysis

57 85

>709

NR 29 NR


A-22



size

CRRT description



severity

Technique Device

Membrane material

Flux

Buffer Anti-

coagulant


Membrane material

Flux



SCr µmol/L % on

pressors

Mean APACHE II


(intensive or not) 34

NR

L achieve dose BUN <60/ <100

mg/dL

NR

A=acetate; APACHE=Acute Physiology and Chronic Health Evaluation; B=bicarbonate; C=cuprophan; CA=cellulose acetate; CAVHDF=continuous arteriovenous hemodiafiltration; CAVHF=continuous arteriovenous hemofiltration; CCT=clinical controlled trial; CrCl=creatinine clearance; CRRT=continuous renal replacement therapy; CTA=cellulose triacetate; CVVHD=continuous venovenous hemodialysis; CVVHDF=continuous venovenous hemodiafiltration; CVVHF=continuous venovenous hemofiltration; CXVHDF=Continuous arterio- or venovenous hemodiafiltration; E=enoxparin; H=heparin; ICU=intensive care unit; IHD=intermittent hemodialysis; L=lactate; N=nadroparin; NR=not reported; P=prostacyclin; PA=polyamide; PAN=polyacrylonitril; PD=peritoneal dialysis; PMMA=polymethylmethacrylate; PS=polysulfone; qRCT=quasi RCT; RCT=randomized controlled trial; SAPS=simplified acute physiology; SCr=serum creatinine; SIRS=systemic inflammatory response syndrome; UK=United Kingdom; URR=urea reduction ratio score; US=United States; wk=week.

Table 2: Quality Assessment of Included Studies – Submodality Comparisons Daud50 Saudan53 Morgera45 Sugahara52 Brause51 Bouman46 Phu57 Schiffl54 Selection criteria description adequate partial partial adequate partial adequate adequate adequate Were treatment groups recruited from same population?

Y Y Y Y Y Y Y Y

Were treatment groups recruited over same period?

Y Y Y Y N Y Y Y

Were dates of trial period reported?

Y Y Y Y Y Y Y Y

Concealment of treatment allocation

unclear adequate unclear unclear inadequate unclear adequate inadequate

Was treatment allocation random?

Y Y* Y Y N Y Y* N

Was trial double-blind? N N N N N N N N Therapeutic regimens description

adequate adequate partial partial adequate adequate adequate partial


A-23

Table 2: Quality Assessment of Included Studies – Submodality Comparisons Daud50 Saudan53 Morgera45 Sugahara52 Brause51 Bouman46 Phu57 Schiffl54 Was sample size calculation described?

partial Y N N N Y Y Y

Was design described as intention-to-treat?

Y Y N N N Y N Y

Was there regression analysis? N Y Y Y N N Y Y

Was there time-series analysis?

NA NA N N N NA NA NA

Was there time-to-event analysis?

N Y N Y NA Y Y N

Were there adequate adjustments for confounding?

Y Y NR Y N Y Y Y

Was there interim analysis? NR NR NR NR N NR Y Y If so, were p values adjusted? NA NA NA NA NA NA N NR How did analysis manage missing data?

NR NR NR NR NR NA NR NR

Were ineligible patients described?

N Y N Y N Y N Y

Was adequacy of treatment allocation tested?

Y Y partial Y Y Y Y partial

Were losses to follow-up described?

N

Y 0%

N

N

partial 20%

Y 0%

N

partial 18%

Were confidence intervals reported?

Y Y Y N N Y Y Y

Were complications reported? N Y N N N Y Y Y Funding sources public NR NR NR NR private private NR Pettila55 Barenbrock47 Ronco12 Heering48 Nand58 Storck49 Gillum56 Selection criteria description adequate partial partial partial inadequate adequate partial Were treatment groups recruited from same population?

Y Y Y Y Y Y Y


Y Y Y NR Y Y Y


Y N Y N N Y N


adequate unclear unclear inadequate unclear unclear inadequate


A-24

Table 2: Quality Assessment of Included Studies – Submodality Comparisons Daud50 Saudan53 Morgera45 Sugahara52 Brause51 Bouman46 Phu57 Schiffl54 Was treatment allocation random?

Y* Y* Y N Y Y Y*

Was trial double-blind? N N N N N N N Therapeutic regimens description

adequate adequate partial adequate partial partial inadequate

Was sample size calculation described?

Y N partial N N Y N


N N Y Y N N N

Was there regression analysis? Y Y Y Y N N N Was there time-series analysis?

Y NA NA N NA N NA


NA NA Y NA N N N

Were there adequate adjustments for confounding?

Y Y Y NR Y Y Y

Was there interim analysis? NR NR NR NR NR Y NR If so, were p values adjusted? NA NA NA NA NA NR NA How did analysis manage missing data?

excluded NR NA NR NR NR NR


Y N partial Y N N N


Y Y Y Y N partial partial


Y 3%

N

Y 0%

N

N

N

N


Y N Y N N N N

Were complications reported? Y Y partial N partial partial partial Funding sources NR NR NR NR NR NR NR

N=no; N*=approximately 25% of patients not randomized to treatment; N**=method used to generate sequence of randomization described and inappropriate; NA=not applicable; NR=not reported; Y=yes; Y*=method used to generate sequence of randomization described and appropriate.


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Table 3: Submodality Evidence Objective Trials Results Authors’ Conclusions Author

Design Sample Size

Outcome* RR (95% CI)†

Continuous submodality comparisons

Comparing technique: hemodiafiltration versus hemofiltration

Saudan53 RCT 206

Mortality 0.63 (0.48,0.82)

These results suggest that increasing dialysis dose, especially for low molecular weight solutes, conferred better survival in severely ill patients with ARF.

Comparing technique: hemodialysis versus hemofiltration

Daud50 RCT 20

Morgera45,52

RCT 24

Mortality

Mortality

1.17 (0.79,1.74)

1.00 (0.45,2.23)

Clinical outcome similar between hemofiltration- and hemodialysis-treated groups. Number of patients studied too small to analyze for differences in outcome or clinical course.

Comparing dialysis flow rates: 2.5 versus 1 L/h in hemofiltration 2.5 versus 1 L/h in hemodialysis 1.5 versus 1 L/h in hemofiltration

Morgera45,52 RCT 24

Brause51

CCT 56

Mortality

Mortality

Mortality

2 (0.56,7.09)

2 (0.56,7.09)

0.94 (0.68,1.32)

Number of patients studied too small to analyze for differences in outcome or clinical course. Clinical outcomes similar between groups.

Comparing dose: 48 versus 20 mL/kg/h in hemofiltration 45 versus 20 mL/kg/h in hemofiltration 35 versus 20 mL/kg/h in hemofiltration

Bouman46 RCT 106

Ronco, 200012 RCT 425

Mortality Dialysis

dependence Mechanical ventilation

Mortality Dialysis

dependence

Mortality Dialysis

dependence

0.83 (0.56,1.22) 0.26 (0.01,6.03)

WMD −3 d (−11,5)

0.72 (0.56,0.91) 1.98 (0.55,7.13) 0.73 (0.58,0.93) 1.52 (0.40,5.83)

In critically ill patients with oliguric ARF, survival at 28 days and recovery of renal function not improved using high ultrafiltrate volumes. Mortality among these critically ill patients high, but increase in rate of ultrafiltration improved survival significantly.


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Design Sample Size


Comparing timing of dialysis initiation: early versus late hemofiltration

Bouman46 RCT 106

Sugahara52

RCT 28

Mortality Dialysis

dependence

Mechanical ventilation Mortality

1.18 (0.81,1.73) 3.83 (0.17,88.62)

WMD −1 d (−6,4)

0.17 (0.05,0.61)

In critically ill patients with oliguric ARF, survival at 28 days and recovery of renal function not improved using early initiation of hemofiltration. Early start of dialysis therapy may help improve survival of patients with ARF after cardiac surgery.

Comparing buffers: bicarbonate versus lactate in hemofiltration bicarbonate versus acetate in hemofiltration lactate versus acetate in hemofiltration

Barenbrock47 RCT 117

Heering48 CCT 132

Mortality Cardiovascular

events

Results for mortality not presented by

group

0.77 (0.48,1.22) 0.39 (0.20,0.79)

not applicable

Data suggest that use of bicarbonate buffer during continuous hemofiltration reduces cardiovascular events in critically ill patients with ARF, particularly those with previous cardiovascular disease or heart failure. Moreover, mortality rate tended to be lower in bicarbonate-treated patients with cardiac failure compared with lactate-treated patients with cardiac failure. Because number of patients is too small in our study, we were unable to show difference in patient mortality.

Comparing: pump-driven versus unpumped in hemofiltration

Storck49 RCT 116

Mortality 0.81 (0.67,0.97)

Volume of ultrafiltrate in patients with ischemic or sepsis-induced ARF correlated with survival rate. This finding suggests that better survival rate in pump-driven hemofiltration group due to faster elimination of middle molecules with high volume hemofilration.

Intermittent submodality comparisons

Comparing schedule: daily versus alternate in hemodialysis

Schiffl54 qRCT 146

Mortality 0.59 (0.39,0.91)

Intensive hemodialysis reduces mortality.

Comparing: intensive versus non-intensive in hemodialysis

Gillum56 qRCT

34

Mortality 1.25 (0.66,2.38) While overall mortality was high in these seriously ill ARF patients, no differences in morbidity and mortality rates between intensive and non-intensive dialysis groups. Sample size too small to answer this question.


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Design Sample Size


Comparing technique: hemodiafiltration versus hemodialysis

Pettila55 RCT 39

Mortality 1.82 (0.68,4.90) Both recovery of renal function and mortality poorer with hemodiafiltration strategy. No definite conclusion could be reached because of small sample and imbalance of significant potential confounders.

ARF=acute renal failure; CCT=clinical controlled trial; CI=confidence interval; CRRT=continuous renal replacement therapy; IPD=intermittent peritoneal dialysis; PD=peritoneal dialysis; qRCT=quasi RCT; RCT=randomized controlled trial; RR=relative risk; WMD=weighted mean difference. *Mortality, renal recovery, or another clinical outcome relevant to this review are reported. †Relative risk reported unless indicated otherwise.


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Table 4: Characteristics of Included Studies – CRRT Versus IHD Comparisons Author Country Setting

Design Objective

N

CRRT Description

IHD Description

Population Population Illness

Severity Technique

Device Membrane

material Flux

Buffer Anti-

coagulant


Membrane material

Flux


Dose Mean age % Male

SCr µmol/L % on

Pressors

Mean APACHE II

% SIRS % Liver Failure

Noble43 UK ICU

Combined CCT and

RCT comparing techniques

128

CXVHDF NR PS

High

B P/H

NR NR

IHD NR C

Low

A/B H

4 h/daily

NR NR

53 71

376 NR

NR 45 0.9

Vinsonneau13 France ICU


360

CVVHDF Prisma PAN High

B H

NR 29 mL/kg/h

IHD variable

PAN High

B H

4 h/alternate days

NR NR

65 73

427 87

SAPS II 64 63 NR

Uehlinger33 Switzerland ICU


125

CVVHDF Prisma PAN High

L H/none

1.8 L/h Ucl ~ 30 mL/min

IHD MiroClav

PS High

B H/none 3 to 4

h/session

NR Ucl 200 mL/min

67 69

339 77

SAPS 55 46 32

Augustine34 US ICU


80

CVVHD NR PS

Low

B H/none

NR Kt/V 3.6/wk

IHD NR PS

Low

B H/none

3 sessions/wk

Kt/V 3.6/wk

NR

61 68

425 54

NR NR NR

Kielstein35 Germany ICU


40

CVVHF BM11/BM14

PS High

B H

3.2 L/h (1×24h session

only)

IHD-extended Genius

PS High

B H

12h/session

NR URR 53%

51 69

329 100

33 82 NR

Kumar42 US ICU


54

CVVHD 2008H

PS/PMMA High

NR H

NR mean serum urea

5 mmol/L

IHD-extended 2008H

PS/PMMA High

B H

6 to 8 h/session,

6 sessions/wk

NR mean serum urea 13

mmol/L

53 63

366 NR

30 NR NR


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Design Objective

N

CRRT Description

IHD Description


Severity Technique

Device Membrane

material Flux

Buffer Anti-

coagulant


Membrane material

Flux



SCr µmol/L % on

Pressors

Mean APACHE II


Gasparovic 36 Croatia ICU


104

CVVHF NR PS NR

NR H

NR 18 and

35 mL/kg/hr

IHD NR PS NR

NR H/none 3 to 4

h/session

NR NR

NR NR NR NR

21 50 NR

Mehta37 US ICU


166

CXVHDF BSM 22/BM-

11 PS/PAN

High

NR H

NR UCl 21.5 mL/min

IHD NR

C/CA/PS/PMMA/PAN Low/high

B H

3 to 4 h/session

NR NR

55 76

398 NR

25 NR 36

John38 Germany ICU


30

CVVHF BSM 22

PS High

B/L H

2 L/h NR

IHD AK 100

PS Low

B H

4 h/session

NR NR

61 87

452 >0

34 100 NR

Stefanidis39 Germany NR


35

CVVHF NR PS

High

NR H

NR NR

IHD NR

PMMA High

NR H

NR

NR NR

61 71 NR NR

NR NR NR

Kierdorf44 Germany NR


100

CVVHF NR

PAN High

NR NR

NR NR

IHD NR

PMMA High

NR NR

6 to 7 session/wk

NR NR

53 61 NR NR

25 41 NR

Davenport40 UK NR


30

CAVHF/CAVHDF

Gemmini PAN High

L H/none

0.9 and 1.4 L/h UCl 17 and 24

mL/min

IHF NR PA

High

L H/none

NR

NR 17 L in

4 h

35 53

608 100

24 0

100

Davenport41 UK ICU


CAVHF NR

PAN

NR H/none

0.4 – 1.0 L/h NR

IHF AB PA

NR H/none

NR

NR NR

31 57

475

NR 0

100


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Design Objective

N

CRRT Description

IHD Description


Severity Technique

Device Membrane

material Flux

Buffer Anti-

coagulant


Membrane material

Flux



SCr µmol/L % on

Pressors

Mean APACHE II


7 High High NR

APACHE=Acute Physiology And Chronic Health Evaluation; A=acetate; B=bicarbonate; C=cuprophan; CA=cellulose acetate; CAVHDF=continuous arteriovenous hemodiafiltration; CAVHF=continuous arteriovenous hemofiltration; CCT=clinical controlled trial; CrCl=creatinine clearance; CRRT=continuous renal replacement therapy; CTA=cellulose triacetate; CVVHD=continuous venovenous hemodialysis; CVVHDF=continuous venovenous hemodiafiltration; CVVHF=continuous venovenous hemofiltration; CXVHDF=continuous arterio- or venovenous hemodiafiltration; E=enoxparin; H=heparin; IHD=intermittent hemodialysis; L=lactate; RCT=randomized controlled trial; qRCT=quasi RCT; P=prostacyclin; PA=polyamide; PAN=polyacrylonitril; PMMA=polymethylmethacrylate; PS=polysulfone; N=nadroparin; NR=not reported; SAPS=Simplified Acute Physiology; SCr=serum creatinine; SIRS=systemic inflammatory response syndrome; UK=United Kingdom; URR=urea reduction ratio score; US=United States; wk=week


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Table 5: Quality Assessment of Included Studies – CRRT versus IHD Noble43 Vinsonneau13 Uehlinger33 Augustine34 Kielstein35 Kumar42 Gasparovic36 Mehta37 Selection criteria description

partial adequate adequate partial adequate partial inadequate adequate

Were treatment groups recruited from same population?

Y Y Y Y Y Y Y Y


Y Y Y Y Y Y Y Y


Y Y Y Y N N N Y


inadequate adequate unclear unclear unclear inadequate unclear unclear

Was treatment allocation random?

N* Y* Y* Y Y Y Y Y*

Was trial double-blind?

N N N N N N N N

Therapeutic regimens description

adequate adequate partial adequate adequate partial partial adequate

Was sample size calculation described?

N Y Y N N N N Y


N Y N Y N N N Y

Was there regression analysis?

N Y Y Y Y Y N Y

Was there time-series analysis?

NA N N N NA N NA N


N Y N Y NA N NA NA

Were there adequate

N Y Y Y Y Y NR Y


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Table 5: Quality Assessment of Included Studies – CRRT versus IHD Noble43 Vinsonneau13 Uehlinger33 Augustine34 Kielstein35 Kumar42 Gasparovic36 Mehta37 adjustments for confounding? Was there interim analysis?

NA N NR NR NR NR NR N

If so, were p values adjusted?

NA NA NA NA NA NA NA NA

How did analysis manage missing data?

NR NA NA NR excluded NR NR NA


N N Y partial N N N Y


Y partial Y Y Y Y N Y


Y 7%

Y 0%

Y 0%

N

Y 3%

N

N

Y 0%


Y Y N Y N N N Y

Were complications reported?

Y Y N N N partial N Y

Funding sources NR mixed public NR private NR NR public


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Table 5: Quality Assessment of Included Studies – CRRT versus IHD John38 Stefanidis39 Kierdorf44† Davenport40 Davenport41 Selection criteria description adequate inadequate inadequate partial partial

Were treatment groups recruited from same population? Y Y Y Y Y Were treatment groups recruited over same period? Y Y Y Y Y Were dates of trial period reported? N N partial N N Concealment of treatment allocation unclear unclear unclear unclear inadequate Was treatment allocation random? Y Y Y Y N** Was trial double-blind? N N N N N Therapeutic regimens description adequate inadequate inadequate partial partial Was sample size calculation described? Y N N N N Was design described as intention-to-treat? N N N N N Was there regression analysis? Y N N Y N Was there time-series analysis? Y N NA N N Was there time-to-event analysis? N N N NA N Were there adequate adjustments for confounding? Y Y Y Y NR

Was there interim analysis? NR NR Y NR NR If so, were p values adjusted? NA NA NA NA NA How did analysis manage missing data? NR NR NA NR NR Were ineligible patients described? N N N N N Was adequacy of treatment allocation tested? Y N partial partial N

Were losses to follow-up described? Y 0%

N

N

N

N

Were confidence intervals reported? N N N Y N Were complications reported? partial partial N N N Funding sources NR NR NR public public

Mixed=public and private funding sources; N=no; N*=approximately 25% of patients not randomized to receive treatment; N**=method used to generate sequence of randomization described and inappropriate; NA=not applicable; NR=not reported; Y=yes; Y*=method used to generate sequence of randomization described and appropriate; †data extracted from thesis.


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Table 6: Number of Dialysis Treatment Days CRRT IHD Test n centre spread n centre spread p value

Kumar42 28 median 6 range 1,31 26 median 5 range 1,28 Mann-Whitney

NS

Vinsonneau13 175 mean 11 95% CI 8,14 184 mean 11 95% CI 8,13 ANOVA

0.84 CI=confidence interval; CRRT=continuous renal replacement therapy; IHD=intermittent hemodialysis.

Table 7: Length of Stay CRRT IHD Test n centre spread n centre spread p value ICU stay (days)

Uehlinger33 70 median 6 range 1,49 55 median 7 range 1,50 Wilcoxon 0.99

Uehlinger33 37 survivors median 6 range 1,38 27 survivors median 6 range 1,49 Wilcoxon 1.00

Mehta37 84 mean 15.1 not reported 82 mean 16.7 not reported t-test NS

Vinsonneau13 175 mean 19 95% CI 15,22 184 mean 20 95% CI 16,23 ANOVA 0.73

Hospital stay (days) Uehlinger33 37 survivors median 20.5 range 6,71 27 median 30 range 2,89 Wilcoxon

0.25 Mehta37 84 mean 17.1 not reported 82 mean 26.3 not reported t-test

<0.01 Kumar42 26 median 24 range 3,135 28 median 15.5 range 1,291 not reported

Vinsonneau13 175 mean 32 95% CI 22,42 184 mean 30 95% CI 24,35 ANOVA 0.66

CI=confidence interval; CRRT=continuous renal replacement therapy; IHD=intermittent hemodialysis.


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APPENDIX 4: Systematic Review Figure 1: Funnel Plot of Mortality

This funnel plot is a simple scatter plot of each trial’s precision (inversion of standard error) on the y-axis against each trial’s log relative risk on the x-axis. Because small trials have less precision and large trials have more precision, the scatter should form an inverted funnel. Markers are sized according to the trial’s sample size (larger trials are marked with larger circles). A vertical line is drawn through our overall log relative risk (0.022; a relative risk of 1.02) to aid the eye in detecting symmetry (an inverted funnel) or asymmetry. Our funnel plot appears to be asymmetric.

Figure 2: ICU Mortality in ARF

ARF=acute renal failure; CHF=continuous hemofiltration; CI=confidence interval; CRRT=continuous renal replacement therapy; ICU=intensive care unit; IHD=intermittent hemodialysis; RR=relative risk.


A-36

Figure 3: Hospital Mortality in ARF

ARF=acute renal failure; CHF=continuous hemofiltration; CI=confidence interval; CRRT=continuous renal replacement therapy; ICU=intensive care unit; IHD=intermittent hemodialysis; RR=relative risk.

Figure 4: Mortality in ARF

ARF=acute renal failure; CHD=continuous hemodialysis; CHF= continuous hemofiltration; CI=confidence interval; CRRT=continuous renal replacement therapy; ICU=intensive care unit; IHD=intermittent hemodialysis; RR=relative risk.


A-37

Figure 5: Dialysis Dependence in ARF Survivors

Figure 6: Dialysis Dependence and Mortality in ARF

Figure 7: Hypotension in ARF

ARF=acute renal failure; CI=confidence interval; CVVHF=continuous venovenous hemofiltration; ICU=intensive care unit; IHD=intermittent hemodialysis; RR=relative risk.


A-38

Figure 8: Change in MAP in ARF at 24 hours or ICU Discharge

Figure 9: Complications in ARF

ARF=acute renal failure; CI=confidence interval; ICU=intensive care unit; IHD=intermittent hemodialysis; RR=relative risk.


A-39

APPENDIX 5: Economic Evaluation Table 1: Baseline Model Parameters for Clinical Events

Variable Value Reference Distribution for Monte Carlo Simulation

Range Considered

Relative Risks mortality (in-hospital) CRRT versus IHD

1.02 meta-analysis (95% CI)

log-normal 0.93 to 1.12

renal recovery (in-hospital) CRRT versus IHD

1.10 meta-analysis (96% CI)

log-normal 0.69 to 1.79

Baseline Probabilities in-hospital mortality risk 0.625 Manns1 normal 0.45 to 0.65 renal recovery probability (in-hospital) 0.714 Manns1 normal 0.46 to 0.82 renal recovery probability among hospital survivors on dialysis (1 year post- hospitalization)

0.10 Manns1 normal 0 to 0.1

risk of returning to dialysis among hospital survivors not on dialysis (1 year post-hospitalization)

0.007 Manns1 not assessed not assessed

annual mortality risk for survivors with dialysis dependence

0.082 Manns1

normal 0.082±0.01

annual mortality risk for survivors with renal recovery

0.072 Manns1 normal 0.072±0.01

Utility Score alive on dialysis 0.62 Manns73

(SD) normal 0.62±0.10

alive with renal recovery 0.82 Hamel71 (SD)

normal 0.82±0.10

CI=confidence interval; CRRT=continuous renal replacement therapy; IHD=intermittent hemodialysis; SD=standard deviation.


A-40

Table 2: Baseline Costs (2005 Canadian dollars) by Clinical Status Status at Hospital Discharge Variable Alive with renal

recovery Alive on Dialysis

Dead Reference

mean ICU days 10.3 11.1 8.9 Manns1 mean ward days 27.9 36.6 3.3 Manns1 cost of hospitalization (excluding in-hospital dialysis)

50,436 61,605 20,484 Capital Health Region*

cost per day CRRT 608 608 608 Manns1 overall cost of CRRT (assuming 7 times/week)

6,262 6,749 5,411 Manns1

cost per run of IHD 397 397 397 Manns1 overall cost of IHD (assuming 3.9 times/week)

2,278 2,455 1,969 Manns1

ongoing annual cost 12,904 88,484 not applicable

Manns1

discount rate for costs 0.05 0.05 0.05 CADTH65 discount rate for utilities 0.05 0.05 0.05 CADTH65

CRRT=continuous renal replacement therapy; ICU=intensive care unit; IHD=intermittent hemodialysis, *Kim Walker, Capital Health, Edmonton: personal communication, 2007.

Table 3: Base Case Cost-Utility Analyses Case Strategy Cost Marginal

Cost Effectiveness

(QALYs) Marginal

Effectiveness (QALYs)

Incremental Cost Per

QALY Gained

CRRT 88,094 2.64 Model 1: primary model (RR based on point estimates from meta-analysis) RR of mortality CRRT versus IHD=1.02 RR of renal recovery CRRT versus IHD=1.10

IHD 96,635 8,541 2.71 0.07 125,960

CRRT 100,314

2.71 Model 2: cost minimization model (RR based on statistical significance) RR of mortality CRRT versus IHD=1.00 RR of renal recovery CRRT versus IHD=1.00

IHD 96,635 −3,679 2.71 0 CRRT dominated

CRRT=continuous renal replacement therapy; IHD=intermittent hemodialysis; RR=relative risk; QALY=quality-adjusted life-year.


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Table 4: Clinical Scenario Analyses Cost (C$) Effectiveness (QALYs) Scenario Model

CRRT IHD Marginal CRRT IHD Marginal Incremental

Cost Per QALY

Gained Clinical event rate: base case

1 88,094 96,635 8,541 2.64 2.71 0.07 125,960

2 100,314 96,635 −3,679 2.71 2.71 0 CRRT dominated

1 98,715 107,573 8,858 2.81 2.87 0.05 164,554 Clinical event rate: Calgary 1999-2002 In-hospital mortality risk 0.596 In-hospital risk of renal recovery 0.68 Post hospitalization renal recovery 0.02

2 111,275 107,573 −3,701 2.87 2.87 0 CRRT dominated

1 135,295 141,898 6,603 2.73 2.78 0.06 109,698 Clinical event rate: systematic review In-hospital mortality risk 0.593 In-hospital risk of renal recovery 0.46

2 145,629 141,898 −3,731 2.78 2.78 0 CRRT dominated

CRRT=continuous renal replacement therapy; IHD=intermittent hemodialysis; QALY=quality-adjusted life-year; base case indicated in italics; model 1 indicated in non-bold; model 2 indicated in bold.

Table 5: Short–Term Cost Scenario Analyses Cost (C$) Effectiveness (QALYs) Scenario Model


Cost Per QALY


1 88,094 96,635 8,541 2.64 2.71 0.07 125,960

2 100,314 96,635 −3,679 2.71 2.71 0 CRRT dominated

1 88,094 95,798 7,704 2.64 2.71 0.07 113,614 SLEDD versus CRRT Cost per day of SLEDD $239 Assumes equal efficacy for SLEDD and IHD

2 100,314 95,798 −4,516 2.71 2.71 0 CRRT dominated

1 88,094 98,308 10,214 2.64 2.71 0.07 150,619 Frequency of IHD in ICU 7 runs per week Assumes equal efficacy for 3 and 7 runs per week of IHD

2 100,314 98,308 −2,007 2.71 2.71 0 CRRT dominated

1 87,763 96,635 8,872 2.64 2.71 0.07 130,835 CRRT to IHD Cross-over 34.6% of patients initially receiving CRRT cross-over to IHD when medically stable

2 99,978 96,635 −3,342 2.71 2.71 0 CRRT dominated


A-42

Table 5: Short–Term Cost Scenario Analyses Cost (C$) Effectiveness (QALYs) Scenario Model


Cost Per QALY

Gained 1 88,094 95,719 7,625 2.64 2.71 0.07 112,442 No nursing costs with

IHD (as per CRRT) Cost per run $224* 2 100,314 95,718 −4,595 2.71 2.71 0 CRRT

dominated 1 90,310 96,635 6,326 2.64 2.71 0.07 93,283 CRRT

anticoagulation (high cost CRRT) citrate anticoagulation $842 per day†

2 102,539 96,635 −5,904 2.71 2.71 0 CRRT dominated

1 87,772 96,635 8,864 2.64 2.71 0.07 130,708 CRRT modality (low cost CRRT) CVVHD (heparin) $574 per day

2 99,991 96,635 −3,356 2.71 2.71 0 CRRT dominated

1 86,626 96,683 10,057 2.64 2.71 0.07 148,309 International costs

(Vitale) Cost per time CRRT $453 Cost per run of IHD $406

2 98,840 96,683 −2,157 2.71 2.71 0 CRRT dominated

CRRT=continuous renal replacement therapy; CVVHD=continuous venovenous hemodialysis; IHD=intermittent hemodialysis; QALY=quality-adjusted life-year; SLEDD=slow low-efficiency daily rate; *base case IHD cost per run=$397; †base case cost per day of CRRT=$608; base case indicated in italics; model 1 indicated in non-bold; model 2 indicated in bold.


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Table 6: Mortality and Dialysis Cost Scenario Analyses Cost (CAN $) Effectiveness (QALYs) Scenario Model


Cost Per QALY


1 88,094 96,635 8,541 2.64 2.71 0.07 125,960

2 100,314 96,635 −3,679 2.71 2.71 0 CRRT dominated

1 77,729 82,346 4,617 2.64 2.71 0.07 68,086 Alternative

annual costs of dialysis (Lee) Annual costs of dialysis $45,076

2 86,025 82,346 −3,679 2.71 2.71 0 CRRT dominated

1 60,103 58,045 −2,057 2.64 2.71 0.07 CRRT dominated

Annual ongoing costs of care same for all survivors Ongoing costs of those on dialysis =$12,904 Ongoing costs of those with renal recovery=$12,904

2 61,724 58,045 −3,679 2.71 2.71 0 CRRT dominated

1 117,488 125,327 7,383 2.64 2.71 0.07 115,587 Hospitalization costs same for all patients

2 129,005 125,327 −3,679 2.71 2.71 0 CRRT dominated


Table 7: Relative Risk One-Way Sensitivity Analyses Cost (C$) Effectiveness (QALYs) Scenario Model


Cost Per QALY


1 88,094 96,635 8,541 2.64 2.71 0.07 125,960

2 100,314 96,635 −3,679 2.71 2.71 0 CRRT dominated

1 97,745 96,635 −1,110 3.05 2.71 0.34 3,246 (CRRT compared to

IHD)

Relative risk of mortality for CRRT compared to IHD=0.93 (lower bound of 95% CI)

2 108,997 96,635 −12,361 3.02 2.71 0.32 39,120 (CRRT compared to

IHD) 1 77,370 96,635 19,266 2.19 2.71 0.52 36,830 Relative risk of

mortality for CRRT compared to IHD=1.12 (upper bound of 95% CI)

2 85,431 96,635 11,205 2.17 2.71 0.54 20,685


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Table 7: Relative Risk One-Way Sensitivity Analyses Cost (C$) Effectiveness (QALYs) Scenario Model


Cost Per QALY

Gained 1 128,027 96,635 −31,392 2.55 2.63 0.16 CRRT

dominated Relative risk of renal recovery for CRRT compared to IHD=0.69 (lower bound of 95% CI)

2 131,549 96,635 −34,914 2.63 2.63 0.07 CRRT dominated

1 58,874 96,635 37,761 2.71 2.71 0 9.3M Relative risk of renal recovery for CRRT compared to IHD=1.79 (upper bound of 95% CI)

2 60,011 96,635 36,624 2.80 2.71 −0.09 IHD dominated


Table 8: Clinical Event Rate One-Way Sensitivity Analyses

Cost (C$) Effectiveness (QALYs) Scenario Model CRRT IHD Marginal CRRT IHD Marginal

Incremental Cost Per

QALY Gained Clinical event rate: base case

1 88,094 96,635 8,541 2.64 2.71 0.07 125,960

2 100,314 96,635 −3,679 2.71 2.71 0 CRRT dominated

1 118,721 131,254 12,533 3.94 3.97 0.03 398,255 In-hospital IHD mortality risk=0.45

2 135,043 131,254 −3,789 3.97 3.97 0 CRRT dominated

1 83,718 91,690 7,971 2.45 2.53 0.07 109,192 In-hospital IHD mortality risk=0.65

2 95,353 91,690 −3,663 2.53 2.53 0 CRRT dominated

1 126,208 132,449 6,242 2.55 2.63 0.07 85,450 Risk of in-hospital renal recovery with IHD=0.46

2 136,158 132,449 −3,708 2.63 2.63 0 CRRT dominated

1 72,188 81,689 9,501 2.68 2.74 0.07 144,778 Risk of in-hospital renal recovery with IHD=0.82

2 85,355 81,689 −3,667 2.74 2.74 0 CRRT dominated

1 88,094 96,635 8,542 2.55 2.60 0.05 189,918 Utility for those on dialysis=0.52 2 100,314 96,635 −3,679 2.60 2.60 0 CRRT

dominated 1 88,094 96,635 8,542 2.73 2.82 0.09 94,228 Utility for those

on dialysis=0.72 2 100,314 96,635 −3,679 2.82 2.82 0 CRRT dominated

1 88,094 96,635 8,542 2.38 2.46 0.08 111,206 Utility for those with renal recovery=0.72

Model 2 100,314 96,635 −3,679 2.46 2.46 0 CRRT dominated


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Table 8: Clinical Event Rate One-Way Sensitivity Analyses Cost (C$) Effectiveness (QALYs) Scenario Model


Cost Per QALY Gained

1 88,094 96,635 8,542 2.89 2.96 0.06 145,228 Utility for those with renal recovery=0.92

2 100,314 96,635 −3,679 2.96 2.96 0 CRRT dominated

1 88,094 96,635 8,542 3.43 3.57 0.14 61,718 Life-years

gained (ICER is cost per life-year)

2 100,314 96,635 −3,679 3.57 3.57 0 CRRT dominated

1 103,080 115,028 11,948 3.42 3.51 0.09 136,266 Discount rate for

cost estimates=0.03 Discount rate for utility estimates=0.03

2 118,707 115,028 −3,679 3.51 3.51 0 CRRT dominated

1 82,835 90,178 7,344 2.37 2.43 0.06 120,761 Discount rate for cost estimates=0.06 Discount rate for utility estimates=0.06

2 93,857 90,179 −3,679 2.43 2.43 0 CRRT dominated

CRRT=continuous renal replacement therapy; ICER=incremental cost-effectiveness ratio; IHD=intermittent hemodialysis; QALY=quality-adjusted life-year; base case indicated in italics; model 1 indicated in non-bold; model 2 indicated in bold.


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N=number of patients. Prevalence of acute renal failure=11.0 per 100,000 population per year Adult Canadian population=22,228,230 (2001 census) Estimated burden of acute renal failure in Canada=2,445 cases per year Cost of IHD per hospitalization=$2,103 Cost of CRRT per hospitalization=$5,757 (*Based on data from Appendix 4 Table 6 and Appendix 5 Table 2) Scenarios of current use of CRRT use are shown in the top row, and scenarios of possible CRRT use are shown in the left column for Canada. For example, if CRRT is used in 46% of acutely ill patients who require renal replacement therapy, the total costs of RRT are $9.3M in Canada annually. Increasing CRRT use to 100%, or decreasing it to 20.9% would result in an increase in costs by $4.8M or a decrease in costs by $2.3M M respectively. For these calculations to be relevant to a given centre, the estimate for the Canadian population can be modified to reflect a region. For example, if the catchment area is 1.3 million, this represents 5.8% of the population (1.3M/22.2M). Thus, the cost savings or increase would be 5.8% of the national estimate.

Table 9: Total Annual Costs of Providing Dialysis Given Various Percentages of Usage of CRRT in Canada Current reported CRRT usage in various centres across Canada 26% CRRT

N=611 CRRT N=1,834 IHD

46% CRRT N=1,125 CRRT N=1,320 IHD

68% CRRT N=1,662 CRRT

N=782 IHD

CRRT Only N=2,445 CRRT

IHD Only N=2,445 IHD

Projected CRRT usage

Total dialysis costs

(million)

Cost difference

from current (million)


(million)

Cost difference (million)


(million)



(million)



(million)


Current 7.4 9.3 11.2 14.1 5.1 0% 5.1 −2.3 5.1 −4.2 5.1 −6.1 5.1 −9.0 5.1 -

1.6% 5.3 −2.1 5.3 −4.0 5.3 −5.9 5.3 −8.8 5.3 +0.2 20.9% 7.0 −0.4 7.0 −2.3 7.0 −4.2 7.0 −7.1 7.0 +1.9 43% 9.0 +1.6 9.0 −0.3 9.0 −2.2 9.0 −5.1 9.0 +3.9

100% 14.1 +6.7 14.1 +4.8 14.1 +2.9 14.1 - 14.1 +9.0


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Potentially relevant citations identified and screened for retrieval (n=2,135)

Citations excluded (n=2,086) irrelevant (n=2,080) irretrievable (n=2) duplicates or multiple publications (n=3) no translator found (n=1)

Articles retrieved for detailed evaluation (n=49)

Articles excluded (n=49) no CRRT or IRRT arm (n=2) not true cost-effectiveness (n=47)

Economic analyses included in systematic review (n=0)

APPENDIX 6: Economic Evaluation Figure 1: Economic Evaluation Studies Considered for Inclusion

CRRT=continuous renal replacement therapy; IRRT= intermittent renal replacement therapy.


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ARF in critically ill patients requiring Renal Replacement Therapy

CRRT IHD

Patient Survival?

No Yes

Renal Recovery?

Yes No

Discharge from Hospital

Alive (dialysis-free) Alive on dialysis

Dead

Treatm

ent

ICU

& In-H

ospital Outcom

es

Post-Hospitalization

Strategies

O

utcomes

Figure 2: Economic Model

CRRT=continuous renal replacement therapy; ICU=intensive care unit; IHD=intermittent hemodialysis.


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1,000 patients undergoing IHD

375 alive 625 dead

107 alive on dialysis

268 alive dialysis- free


14 alive dialysis-free 33 dead







Discharge

5 years 10 years

Time

Figure 3: Model Outcomes from IHD Arm


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Figure 4: One-way Sensitivity Analysis of RR of In-Hospital Death and Renal Recovery for CRRT versus IHD (Model 1)

CRRT=continuous renal replacement therapy; IHD=intermittent hemodialysis; RRT=renal replacement therapy; base case ICER represented by dashed line.

RR of in-hospital death for CRRT versus IHD (0.93 to 1.12) RR of in-hospital renal recovery for CRRT versus IHD (0.69 to 1.79)

Incremental cost-effectiveness


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Figure 5: One-way Sensitivity Analysis for CRRT versus IHD (Model 1)

Base case ICER represented by dashed line.

baseline in-hospital risk of death (0.45 to 0.65)

utility estimate for dialysis-dependent patients (0.52 to 0.72)

mortality after discharge – no dialysis (0.037 to 0.127)

daily cost of CRRT (397 to 842)

baseline in-hospital probability of renal recovery (0.46 to 0.82)

probability of renal recovery post-discharge (0 to 0.1)

utility estimate for survivors – no dialysis (0.72 to 0.92)

mortality for those discharged on dialysis (0.038 to 0.05)

Incremental cost-effectiveness


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Figure 6: Incremental Cost-effectiveness Ratio (ICER) Scatter Plot Comparing CRRT to IHD

IHD is baseline group.


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APPENDIX 7: Studies for Economic Analysis Mehta37 A randomized clinical trail of continuous versus intermittent dialysis for acute renal failure. Review of economic studies. 4 academic medical centres in southern California. RCT. Patient population composed of adult ICU patients with ARF, who required renal replacement therapy, with mean arterial BP >70 mm Hg in 8 hours before randomization, and mean age 56.3 years (IHD) and 54.5 years (CRRT). Sample size of 166 patients who were randomized. Intervention: IHD versus CRRT. Funding from Agency for Health Care Policy Research ROI HS06466. Manns1 Cost of acute renal failure requiring dialysis in the intensive care unit: Clinical and resource implications of renal recovery. Review of economic studies; economic evaluation (baseline event rates, cost of IHD and CRRT). 2 tertiary-care hospitals in Calgary Health Region, servicing population of 1.3 million. Observational retrospective cohort study of all patients who developed acute renal failure and required dialysis between April 1, 1996 and March 31, 1999. Patient population composed of all patients who developed acute renal failure and required dialysis between April 1, 1996 and March 31, 1999, with average age 59.3 years (16.7 standard deviation). Sample size of 261 patients. Of 98 survivors, 1-year follow-up data available for 66 patients. Additional unpublished 4-year follow-up obtained for this cohort of surviving patients from Calgary Health Region administrative dataset (through which vital status and dialysis dependence could be determined). RRT related costs determined from 178 CRRT and 83 IHD patients. Hospitalization costs available from 70 patients alive with renal recovery, 28 patients alive on dialysis, and 163 patients dead at hospital discharge. Follow-up data available for risk of death, renal recovery, and dialysis dependence for 20 patients on dialysis and 46 who were dialysis-free at hospital discharge. Intervention: none. Funding from Kidney Foundation of Canada and Alberta Heritage Foundation for Medical Research. Bagshaw70 One-year mortality in critically ill patients by severity of kidney dysfunction: a population-based assessment. Economic analysis (baseline event rates) ICUs in Calgary Health Region. Population-based surveillance cohort of patients admitted to adult ICUs from May 1, 1999 to April 30, 2002. Patient population composed of subpopulation of 240 (total 5,693 patients) who had severe ARF requiring dialysis. Subgroup had average age of 62.7 years (standard deviation 15.3). Patients followed for 1 year. Sample size of 240. Intervention: none. Funding from Canadian Intensive Care Foundation. Hamel71 Outcomes and cost-effectiveness of initiating dialysis and continuing aggressive care in seriously ill hospitalized adults. Economic analysis (quality of life). 5 academic centres in US. Prospective observational study from 1989 to 1994.


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Patient population composed of patients with serious illness requiring initiation of acute dialysis therapy. 490 patients recruited, with baseline age of 61 years (25th and 75th percentile, 46 to 69). Of these, 27% alive 6 months after enrolment. Sample size: of 27% who were alive at 6 month, 57 had measurement of quality of life using time trade-off method. Intervention: none. Funding from Robert Wood Johnson Foundation. Manns73 Quality of life in patients treated with hemodialysis or peritoneal dialysis: what are the important determinants? Economic analysis (quality of life). Academic medical centre in Alberta. Observational cohort study. Patient population of prevalent dialysis patients (>6 months), with average age of 60.8 years. Sample size of 192 patients. Intervention: none. Funding from Institute of Health Economics. Laupacis72 A study of the quality of life and cost-utility of renal transplantation. Economic analysis (quality of life). Academic medical centres in Ontario. Observational cohort study. Patient population of prevalent dialysis patients pre-transplant who received a kidney transplant. Sample size of 168 patients. Intervention: none.


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APPENDIX 8: Forms SR CRRT and IHD Relevance Form Reviewer _______________________ Study ID ________________________ Please assess each screened-in article according to criteria below. Preliminary 1a. Does this article contain original research? Yes No If no, does it contain non-original but potentially relevant research? [ ] review or commentary [ ] letter or comment 1b. Were study participants human? Yes No Study Design: 2. Was study a prospective controlled trial? Yes No [ ] parallel RCT [ ] parallel CCT [ ] with >allocated participants? Population: 3a. Was population adults? Yes No [ ] ≥16 years and over [ ] other (specify, e.g., means) [ ] not reported (assumed)? 3b. Did study population have ARF? Yes No Interventions: 4. Did arm or arms of study receive continuous renal Yes No

replacement therapy (CRRT) or intermittent hemodialysis (IHD)? Check all that apply. [ ] CAVHD [ ] CAVHF [ ] CAVHDF [ ] CVVHD [ ] CVVHF [ ] CVVHDF [ ] SCUF [ ] IHD (non-continuous form of dialysis)?

Outcome: 5. Are any one of following an outcome in study? Check all that apply: Yes No

[ ] mortality (i.e., ICU, hospital, post-discharge) [ ] length of stay in ICU [ ] length of hospitalization [ ] incidence of chronic renal impairment (no dialysis, but also does not return to normal) [ ] change in renal function (i.e., change in SCr, CrCI, GFR) [ ] incidence of chronic dialysis treatment (or renal recovery) [ ] number of dialysis treatments [ ] QOL [ ] dialysis-related complications (e.g., catheter-associated sepsis, life-threatening electrolyte abnormalities, bleeding, hypotension)? Final decision: Should this study be included in next stage? Yes No (Answer yes if all the above are yes)

Unsure Yes No 3rd Party


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SR CRRT and IHD Quality Form Reviewer _______________________ Study ID ________________________ Methods Part 1: Trial Protocol (Chalmers) [4]* 1. Selection description (setting, inclusion, exclusion criteria) Adequate Partial Inadequate (must include ARF definition) 2. Therapeutic regimens definitions reported Adequate Partial Inadequate (must include technique, filter, Qb, Qd, and dose/schedule or Kt/v or URR) Part 2: Internal validity-confounding (selection of bias) (Downs and Black) [5]* 1. Were patients in different intervention groups Yes No NR

recruited from same population? (all RCTs) 2. Were study subjects in different intervention Yes No NR

groups recruited over same period? (all RCTs)

Part 3: (Schulz) [3]* 1. Concealment of treatment allocation Adequate Inadequate Unclear Adequate: e.g., central randomization; numbered or coded containers; drugs prepared by pharmacy; serially numbered, opaque, sealed envelopes. Inadequate: e.g., alternation, use of case record numbers, dates of birth or day of week open lists. Unclear: allocation concealment approach not reported or fits neither of above categories. Part 4: (Jadad) [2]* 1. Randomization

a. Was study described as randomized (this Yes No includes use of words such as randomly, random, and randomization)? b. Method to generate sequence of Yes No

randomization described and appropriate (e.g., table of random numbers, computer- generated, coin tossing)

c. Method of randomization described and Yes No

inappropriate (allocated alternately, according to date of birth or hospital number)

2. Double-blind

a. Was study described as double-blind? Yes No b. Method of double-blinding described and Yes No

appropriate (identical placebo, active placebo, dummy)

c. Method of double-blinding described and Yes No

inappropriate (comparison of tablet versus injection with no double dummy)


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SR CRRT and IHD Quality Form Reviewer: _______________________ Study ID: ________________________ Part 5: Blinding Subject-blinded: Yes No Unclear or NR

(placebo, DB) Investigator-blinded (those who treat): Yes No Unclear or NR Outcome assessor-blinded: Yes No Unclear or NR

Part 6: Trial Protocol (Chalmers) [4]* 1. Prior estimate of numbers (endpoints selected, difference Yes Partial No

of clinic interest alpha and beta estimated)

2. Dates of starting and stopping accession (from Yes No randomization or screening)

Part 7: Statistical Analysis (Chalmers) [4]* 1. Time-series analysis (repeated measures, mixed Yes No NA

models)

2. Time-to-event analysis (KM, Cox, log-rank, log-logistic, Yes No NA log-normal, Weibull)

3. Regression analysis (ANOVA, linear, Cox, Poisson) Yes No NA 4. Interim analysis Yes No Unknown or NR

5. If so, were p values adjusted (O’Brien-Fleming, Yes No NR or NA

Pocock, haybittle-Peto)?

Part 8: Internal validity-confounding (selection bias) (Downs and Black) [5]* 1. Was there adequate adjustment for confounding in Yes No NR

analyses from which main findings drawn? (for observational studies must include age, severity of ARF [e.g., APACHE]; no adjustment required for RCTs unless some variables unbalanced)

Part 9: Design analysis 1. Was design described as intention-to-treat? Yes No 2. How did analysis manage missing data?

Excluded from analysis Worst or best case NR Multiple imputations Last value carried forward N/A Other (specify) _______________________ Results: Part 1: Trial Protocol (Chalmers) [4]* 1. Number of patients seen and reject log reported: Yes Partial No

(no reason given)

2. Testing randomization Yes Partial No (at least 5 variables with p values)


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SR CRRT and IHD Quality Form Reviewer: _______________________ Study ID: ________________________

3. Testing Blinding NA Yes Partial No (one party)

4. Testing compliance NA Yes Partial No Part 2: Withdrawals and Dropouts (Jadad) [2]* Was there description of withdrawals and drop-outs Yes Partial No (number by group must be included)? If there were losses to follow-up or withdrawals, give numbers and describe reasons given by group. N should be number randomized minus number “excluded” (i.e., ineligible). If not, please indicate. Treatment: Control: All: n/N= n/N= n/N= Part 3: Statistical Analysis (Chalmers) [4]* 1. Confidence limits reported (or ranges or Yes No inter-quartiles ranges for non-parametric analyses) 2. Side effects, statistical discussion (e.g., bleeding, Yes Partial No or NR hypotension, catheter-associated sepsis, life- (must include p values) threatening electrolyte abnormalities) Report of funding: Part 1: (roughly from Cho) [1]* Funding sources (check all that apply): Government Internal Private industry Foundation Other (specify) NR No funding Bibliography: 1. Cho MK, Bero LA. The quality of drug studies published in symposium proceedings. Ann intern Med 1996;124(5):485-9 2. Jadad AR, Moore RA, Carrol D, Jenkinson C, Reynolds JM, Gavahan DJ, et al. Assessing the quality of reports of randomized clinical trials:

Is blinding necessary? Control Clin Trials 1996;17:1-12 3. Schulze KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. JAMA 1995;273(5):408-12 4. Juni P, Altman DG and Egger M: Assessing the quality of randomised controlled trials, in Egger M, Davey Smith G and Altman DG (eds):

Systematic reviews in health care. London, UK, BMJ Books, 2001, pp 87-108 5. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-

randomised studies of health care interventions. J Epidemiol Community Health 1988; 52:377-84.


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SR CRRT and IHD Relevance Form Reviewer: _______________________ Economic Evaluations Study ID: ________________________ Please assess each screened-in article according to criteria below. Preliminary: 1. Was this true cost-effectiveness evaluation [i.e., Yes No determine impact of continuous renal replacement therapy (CRRT) on relevant costs and health benefits]? Population: 2a. Was population to which economic evaluation is Yes No focused on adults? [ ] ≥16 years [ ] other (specify, e.g., means) [ ] not reported (assumed)? 2b. Did study population have ARF? Yes No Interventions: 3a. Did arm or arms of study receive CRRT Yes No

or intermittent hemodialysis (IHD)? Check all that apply: [ ] CAVHD [ ] CAVHF [ ] CAVHDF [ ] CVVHD [ ] CVVHF [ ] CVVHDF [ ] SCUF [ ] IHD (non-continuous form of dialysis)?

3b. Were ≥2 arms compared? Yes No Cost Outcome: 4. Is cost included as outcome in study? Yes No Efficacy or Safety Outcome: 5. Is any one of following an outcome in study? Check all that apply: Yes No

[ ] mortality (i.e., ICU, hospital, post-discharge) [ ] length of stay in ICU [ ] length of hospitalization [ ] incidence of chronic renal impairment (no dialysis, but also does not return to normal) [ ] change in renal function (i.e., change in SCr, CrCI, GFR) [ ] incidence of chronic dialysis treatment (or renal recovery) [ ] no. of dialysis treatments [ ] QOL [ ] dialysis-related complications (e.g., catheter-associated sepsis, life-threatening electrolyte abnormalities, bleeding, hypotension)? [ ] other clinical outcome or health benefit, state ________________________________________ Final decision: Should this study be included in next stage? Yes No (Answer yes if all above are yes)

Unsure Yes No 3rd Party

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