Timing of initiation of renal replacement therapy for patients with acute kidney injury: A meta‐analysis of RCTs

• Published in: Therapeutic apheresis and dialysis Vol. 27; no. 2; pp. 207 - 221
• Main Authors: Li, Yunjie, Zhang, Yong, Li, Rui, Zhang, Ming, Gao, Xiang
• Format: Journal Article
• Language: English
• Published: Kyoto, Japan John Wiley & Sons Australia, Ltd 01.04.2023
• Subjects: Acute Kidney Injury - therapy; Continuous Renal Replacement Therapy; Humans; initiation; meta‐analysis; randomized controlled trials; Randomized Controlled Trials as Topic; Renal Dialysis; renal replacement therapy; Renal Replacement Therapy - methods; Time-to-Treatment; meta-analysis; renal replacement therapy; initiation; randomized controlled trials
• ISSN: 1744-9979; 1744-9987
• DOI: 10.1111/1744-9987.13914

Purpose To assess the effects of delayed versus early renal replacement therapy (RRT) initiation for patients with AKI. Methods Related RCTs of RRT initiated at different times published on PubMed, Web of Science, Embase, and Cochrane Library were searched. Results Fifteen RCTs studies with 5395 patients were included. The results showed that the 28‐day mortality (RR 1.01; 95% CI 0.94 ~ 1.08; p = 0.80), 60‐day mortality (RR 1.00; 95% CI 0.91 ~ 1.11; p = 0.93), 90‐day mortality (RR 1.01; 95% CI 0.94 ~ 1.08; p = 0.80), dialysis dependence among survivors (RR 0.67; 95% CI 0.40 ~ 1.13; p = 0.13), length of ICU stay (RR −1.32; 95% CI −3.26 ~ 0.62; p = 0.18) and length of hospital stay among survivors(RR −0.98; 95% CI −2.89 ~ 0.92; p = 0.31) were not significantly different between the two groups. In addition, early initiation of RRT increases the incidence of hypotension (RR 1.42, 95% CI 1.23 ~ 1.63; p < 0.00001) and infectious (RR 1.36; 95% CI 1.03 ~ 1.80; p = 0.03) events. Conclusion Early initiation of RRT cannot improve the prognosis and benefit patients.