The optimal time of initiation of renal replacement therapy in acute kidney injury: A meta-analysis.

Kaiping Luo,Weidong Fang,Shufang Fu,Gaosi Xu

doi:10.18632/oncotarget.17946

Abstract

BackgroundThe impact on the timing of renal replacement therapy (RRT) initiation on clinical outcomes for patients with acute kidney injury (AKI) remains controversial.Materials and methodsWe searched the Cochrane Library, EMBASE, Global Health, MEDLINE, PubMed, the International Clinical Trials Registry Platform, and Web of Science.ResultsWe included 49 studies involving 9698 patients. Pooled analysis of 5408 critically ill patients with AKI showed that early RRT was significantly associated with reduced mortality compared to late RRT [odds ratio (OR), 0.40; 95% confidential intervals (CI), 0.32 - 0.48; I2, 50.2%]. For 4290 non-critically ill patients with AKI, there was no statistically significant difference in the risk of mortality between early and late RRT (OR, 1.07; 95% CI, 0.79 - 1.45; I2, 73.0%). Early RRT was markedly associated with shortened intensive care units (ICU) length of stay (LOS) and hospital LOS compared to late RRT in both critically ill and non-critically ill patients with AKI.ConclusionsEarly RRT probably reduce the mortality, ICU and hospital LOS in critically ill patients with AKI. Inversely, early RRT in non-critically ill patients with AKI did not decrease the mortality, but shortened the ICU and hospital LOS.

Highlights

Acute kidney injury (AKI) is increasingly common and associated with adverse clinical outcomes, including excess mortality and morbidity, and prolonged hospital length of stay (LOS) [1,2,3,4]
Pooled analysis of 5408 critically ill patients with acute kidney injury (AKI) showed that early renal replacement therapy (RRT) was significantly associated with reduced mortality compared to late RRT [odds ratio (OR), 0.40; 95% confidential intervals (CI), 0.32 - 0.48; I2, 50.2%]
RRT was markedly associated with shortened intensive care units (ICU) length of stay (LOS) and hospital LOS compared to late RRT in both critically ill and noncritically ill patients with AKI

Summary

Introduction

Acute kidney injury (AKI) is increasingly common and associated with adverse clinical outcomes, including excess mortality and morbidity, and prolonged hospital length of stay (LOS) [1,2,3,4]. Renal replacement therapy (RRT) is the cornerstone for the treatment of severe AKI. RRT provokes a considerable escalation in the complexity of therapy, the optimal timing of initiation of RRT in patients with AKI has been the focus of those debates [5, 6]. Some data suggested that early compared with late RRT reduced the mortality with better renal recovery. We hypothesized that the different severity of illness for patients with AKI who received early RRT may produce distinct effects on mortality. We firstly performed a meta-analysis according to the severity of illness for patients with AKI to investigate the opportunity of RRT initiation. The impact on the timing of renal replacement therapy (RRT) initiation on clinical outcomes for patients with acute kidney injury (AKI) remains controversial

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Discussion

Conclusion