Comparing Cardiovascular Morbidity and Mortality in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy Versus Sustained Low-Efficiency Dialysis: A Systematic Review.

Abstract

This systematic review evaluated the comparative effectiveness of continuous renal replacement therapy and sustained low-efficiency dialysis in critically ill adults with acute kidney injury, with a particular focus on hemodynamic and cardiovascular outcomes. A comprehensive literature search across major databases identified six eligible studies, including one randomized controlled trial, one randomized crossover trial, and four observational cohorts. Across these studies, mortality outcomes were similar between modalities, with no evidence of a survival advantage for continuous renal replacement therapy. Hemodynamic results were likewise comparable, as both therapies maintained stable mean arterial pressure, demonstrated parallel Sequential Organ Failure Assessment (SOFA) score trends, and showed no meaningful differences in vasopressor needs or cardiovascular stress markers. Some studies reported modest improvements in hemodynamic tolerance and fewer circuit-related complications with sustained low-efficiency dialysis, reflecting potential practical benefits in daily intensive care unit practice. Despite variability in study designs and heterogeneity in dialysis protocols, the overall evidence suggests that sustained low-efficiency dialysis offers a safe and effective alternative to continuous renal replacement therapy, particularly in resource-limited settings where logistical or operational constraints may influence modality choice. Further large, standardized trials are needed to refine patient-centered modality selection and to better characterize long-term cardiovascular outcomes.