New Insights on Continuous Renal Replacement Therapy for Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis.

Summary

Across 36 studies (n=2123), adjunctive CRRT in ARDS was associated with lower mortality, reduced VAP incidence, shorter ICU stay and ventilation time, improved oxygenation indices up to 7 days, and lower EVLWI, APACHE II, TNF-α, and IL-6. Overall evidence quality was low, underscoring the need for high-quality multicenter RCTs.

Key Findings

• Across 36 studies (2123 patients), CRRT plus conventional therapy was associated with reduced mortality in ARDS.
• Secondary outcomes improved: lower VAP incidence, shorter ICU length of stay and mechanical ventilation duration.
• Respiratory function improved (higher oxygenation index at 24h, 48h, 72h, and 7 days) and lower EVLWI.
• Systemic severity and inflammation decreased (lower APACHE II, TNF-α, and IL-6) with CRRT.
• Evidence quality rated low; substantial heterogeneity indicates need for robust multicenter RCTs.

Clinical Implications

Consider CRRT in select ARDS patients (e.g., with fluid overload or systemic inflammation) within clinical trials or protocols, while acknowledging current evidence is low quality and heterogeneous.

Limitations

• Overall low study quality and heterogeneity limit causal inference
• Potential publication bias and variability in CRRT protocols and patient selection

Future Directions

Design multicenter, adequately powered RCTs with standardized CRRT protocols and predefined patient phenotypes (e.g., hyperinflammatory, fluid-overloaded) to validate mortality benefit.