Authors: Georges Khattar, Khalil El Gharib, Ngowari Pokima, Juliet Kotys, Vineeth Kandala, Jonathan Mina, Fadi Haddadin, Saif Abu Baker, Samer Asmar, Taqi Rizvi, Matthew Flamenbaum, Dany Elsayegh, Michel Chalhoub, Halim El Hage, Suzanne El Sayegh
Published in: Journal of Intensive Care Medicine, 2024
Conclusion: The findings challenge the assumption that GDFR is the optimal approach for managing sepsis in ESRD patients. The results suggest that GDFR may not be superior to conservative fluid management and could potentially be harmful. This indicates a need for cautious consideration of fluid resuscitation strategies in this vulnerable patient population. Further research is warranted to refine guidelines and optimize care for ESRD patients with sepsis.
Methods: Following the PRISMA guidelines, a systematic review was conducted across multiple databases to identify relevant studies up until October 1, 2023. The search focused on examining fluid resuscitation strategies in ESRD patients with sepsis. The review process was managed using Covidence software, and discrepancies in study inclusion were resolved by a fourth reviewer. A random-effects model with the Mantel-Haenszel method was used to integrate odds ratios (ORs) for 90-day mortality and intubation rates. Sensitivity analysis and publication bias assessments were also conducted.
Results: Out of 1,274 identified studies, 10 studies involving 1,184 patients were included. Among these, 593 patients received GDFR. Four studies specifically examined the intubation rate in 304 patients. The meta-analysis found no significant differences in mortality [OR = 1.23; 95% CI = 0.92-1.65; I² = 0%] or intubation rates [OR = 1.91; 95% CI = 0.91-4.04] between GDFR and conservative management groups. Sensitivity analysis showed higher mortality and intubation rates in some studies, though this was not consistent across all studies. The Egger test indicated no significant publication bias.
Khattar, G., El Gharib, K., Pokima, N., Kotys, J., Kandala, V., Mina, J., Haddadin, F., Abu Baker, S., Asmar, S., Rizvi, T. and Flamenbaum, M., 2024. Fluid Resuscitation Dilemma in End-stage Renal Disease Patients Presenting with Sepsis: A Systematic Review and Meta-analysis. Journal of Intensive Care Medicine, p.08850666241261673.