{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:58:05Z","timestamp":1790618285975,"version":"4.1.0"},"reference-count":20,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,1,21]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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\u2009mL\/kg\/hour, with a need to consider further augmentation to 25\u201330\u2009mL\/kg\/hour. Observational data have shown that lower-dose CRRT (&lt;20\u2009mL\/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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>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\u2014of 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 (&lt;20\u2009mL\/kg\/hour) compared with guideline-directed standard dose-intensity CRRT (\u226520\u201340\u2009mL\/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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethics approval is not required as primary data will not be collected. Findings of this review will be disseminated through peer-related publication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD420251135606.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-112086","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T11:30:29Z","timestamp":1769772629000},"page":"e112086","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Lower versus standard dose-intensity continuous renal replacement therapy: a protocol for a systematic review and meta-analysis"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct06014801","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06021288","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06446739","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1506-4253","authenticated-orcid":false,"given":"Nuttha","family":"Lumlertgul","sequence":"first","affiliation":[{"name":"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"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3885-9377","authenticated-orcid":false,"given":"Prit","family":"Kusirisin","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada"},{"name":"Division of Nephrology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8676-8675","authenticated-orcid":false,"given":"Janice Y","family":"Kung","sequence":"additional","affiliation":[{"name":"Geoffrey & Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u2019Arcy","family":"Duquette","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoko","family":"Fujii","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, The Jikei University School of Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2124-1714","authenticated-orcid":false,"given":"Alexander","family":"Zarbock","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital of M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron","family":"Wald","sequence":"additional","affiliation":[{"name":"Li Ka Shing Knowledge Institute of St. Michael's Hospital, St Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"Department of Nephrology and Hypertension, Tel Aviv Sourasky Medical Center, Tel Avviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean M","family":"Bagshaw","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"2026013003302023000_16.1.e112086.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0902413"},{"key":"2026013003302023000_16.1.e112086.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0802639"},{"key":"2026013003302023000_16.1.e112086.3","doi-asserted-by":"publisher","DOI":"10.1186\/cc11454"},{"key":"2026013003302023000_16.1.e112086.4","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.ekir.2017.11.018","article-title":"Effect of Frequent Dialysis on Renal Recovery: Results From the Acute Renal Failure Trial Network Study","volume":"3","author":"Vijayan","year":"2018","journal-title":"Kidney Int 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