{
  "abstract": "Introduction The 2012 Kidney Diseases Improving Global Outcomes clinical practice guideline recommends prescribing continuous renal replacement therapy (CRRT) doses in patients with acute kidney injury (AKI) between 20 and 25 mL/kg/hour, with a need to consider further augmentation to 25–30 mL/kg/hour. Observational data have shown that lower-dose CRRT (<20 mL/kg/hour) may be tolerated and reduce adverse effects related to higher or guideline-directed standard dose-intensity CRRT. We aim to conduct a systematic review and meta-analysis of current evidence regarding tolerability, safety and clinical outcomes of lower CRRT dose-intensity compared with guideline-directed standard dose-intensity CRRT.Methods and analysis Ovid MEDLINE, Ovid Embase, CINAHL and Cochrane Library will be searched for studies from inception to present. We will evaluate the risk of bias using the modified Cochrane tool for randomised controlled trials and the Cochrane Risk of Bias In Non-randomised Studies—of Interventions tool for cohort studies. Two reviewers will independently complete study selection, data extraction and bias assessment. Inclusion criteria will be randomised controlled trials and observational studies (cohort) including patients with AKI receiving CRRT. The exposure will be lower dose-intensity CRRT (<20 mL/kg/hour) compared with guideline-directed standard dose-intensity CRRT (≥20–40 mL/kg/hour). Outcomes will include intensive care unit and hospital mortality, dialysis duration and dependence and indicators of metabolic control. Pooled random-effect meta-analysis ORs with 95% CIs will be reported, if able.Ethics and dissemination Ethics approval is not required as primary data will not be collected. Findings of this review will be disseminated through peer-related publication.PROSPERO registration number CRD420251135606.",
  "authors": [
    {
      "affiliations": [
        "Division of Nephrology, Department of Medicine, Excellence for Critical Care Nephrology, King Chulalongkorn Memorial Hospital and Centre of Excellence in Critical Care Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"
      ],
      "name": "Nuttha Lumlertgul"
    },
    {
      "affiliations": [
        "Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada",
        "Division of Nephrology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand"
      ],
      "name": "Prit Kusirisin"
    },
    {
      "affiliations": [
        "Geoffrey & Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Janice Y Kung"
    },
    {
      "affiliations": [
        "Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "D’Arcy Duquette"
    },
    {
      "affiliations": [
        "Intensive Care Unit, The Jikei University School of Medicine, Tokyo, Japan"
      ],
      "name": "Tomoko Fujii"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital of Münster, Münster, Germany"
      ],
      "name": "Alexander Zarbock"
    },
    {
      "affiliations": [
        "Li Ka Shing Knowledge Institute of St. Michael's Hospital, St Michael’s Hospital, Toronto, Ontario, Canada",
        "Department of Nephrology and Hypertension, Tel Aviv Sourasky Medical Center, Tel Avviv, Israel"
      ],
      "name": "Ron Wald"
    },
    {
      "affiliations": [
        "Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada"
      ],
      "name": "Sean M Bagshaw"
    }
  ],
  "title": "Lower versus standard dose-intensity continuous renal replacement therapy: a protocol for a systematic review and meta-analysis",
  "uid": "179bbd88-18fc-50d7-8788-364176cbbedd"
}