MO346: Timing of Renal Replacement Therapy Initiation in Patients With Septic Acute Kidney Injury: A Systematic Review and Meta-Analysis

Abstract

Abstract BACKGROUND AND AIMS To evaluate the optimal timing of renal-replacement therapy (RRT) initiation with a systemic review and meta-analysis in the patients with septic acute kidney injury (AKI). METHOD Systemic searches of PubMed, Cochrane and Embase databases from their inception to June 2021 were investigated. Studies that reported original data that specifically mentioned applying RRT in septic patients with AKI were selected. And, full-text reviews were performed by two reviewers independently with the following eligibility criteria: (1) observational cohort and/or randomized clinical trial (RCT) design; (2) adult septic patients; (3) diagnosis of AKI; (4) description of factors related to the timing of RRT initiation; and (5) description of mortality outcomes. RESULTS Among a total of six studies including 1058 patients, the 28-day mortality rate was significantly lower in the early RRT-treated group compared with the late group [RR = 0.69; 95% confidence interval (95% CI) (0.51–0.94); P = 0.018]. Moreover, among the five studies including 938 patients, the 90-day mortality rate was also significantly lower in the early RRT-treated group than in the late group [RR = 0.61; 95% CI (0.47–0.80); P = 0.01]. In a subgroup analysis for continuous RRT (CRRT), we also found significantly lower 28- and 90-day mortality rates in the early CRRT-treated group compared with the late group. CONCLUSION This study showed that early initiation of RRT might reduce 28- and 90-day mortality compared with late initiation in septic AKI patients.