The impact of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury on mortality and clinical outcomes: a meta-analysis

• Type: Article in International Scientific Journal
• Date: 2022

Authors

Castro, I (Author) Other; Relvas, M (Author) Other; Gameiro, J (Author) Other; Lopes, JA (Author) Other; Matilde Soares (Author) FMUP; Luís Coentrão (Author) FMUP

Journal

Title: CKJ: Clinical Kidney Journal

Vol. 15

Pages: 1932-1945

ISSN: 2048-8505

Publisher: Oxford University Press

Indexing

ISI Web of Knowledge - 0 Citations

Scopus

Other information

Authenticus ID: P-00W-WPT

DOI: 10.1093/ckj/sfac139

Abstract (EN): Background Renal replacement therapy (RRT) is essential in the presence of life-threatening complications associated with acute kidney injury (AKI). In the absence of urgent indications, the optimal timing for RRT initiation is still under debate. This meta-analysis aims to compare the benefits between early and late RRT initiation strategies in critically ill patients with AKI. Methods Studies were obtained from three databases [Medical Literature Analysis and Retrieval System Online (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus], searched from inception to May 2021. The selected primary outcome was 28-day mortality. Secondary outcomes included overall mortality, recovery of renal function (RRF) and RRT-associated adverse events. A random-effects model was used for summary measures. Heterogeneity was assessed through Cochrane I-2 test statistics. Potential sources of heterogeneity for the primary outcome were sought using sensitivity analyses. Further subgroup analyses were conducted based on RRT modality and study population. Results A total of 13 randomized controlled trials including 5193 participants were analysed. No significant differences were found between early and late RRT initiation regarding 28-day mortality [risk ratio (RR) 1.00; 95% confidence interval (CI) 0.89-1.12, I-2 = 30%], overall mortality (RR 1.00; 95% CI 0.90-1.12, I-2 = 42%) and RRF (RR 1.02; 95% CI 0.92-1.13, I-2 = 53%). However, early RRT initiation was associated with a significantly higher incidence of hypotensive (RR 1.34; 95% CI 1.17-1.53, I-2 = 6%) and infectious events (RR 1.83; 95% CI 1.11-3.02, I-2 = 0%). Conclusions Early RRT initiation does not improve the 28-day and overall mortality, nor the likelihood of RRF, and increases the risk for RRT-associated adverse events, namely hypotension and infection.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 14