Timing of initiation of renal replacement therapy for patients with acute kidney injury: A meta-analysis of RCTs
Yunjie Li
School of Clinical Medicine, Weifang Medical University, Weifang, Shandong, China
Search for more papers by this authorYong Zhang
Department of Critical Care Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
Search for more papers by this authorRui Li
Department of Critical Care Medicine, Chongqing Kaizhou District People's Hospital, Kaizhou, Chongqing, China
Search for more papers by this authorMing Zhang
Department of Critical Care Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
Search for more papers by this authorCorresponding Author
Xiang Gao
Department of Critical Care Medicine, Weifang People's Hospital, Weifang, Shandong, China
Correspondence
Xiang Gao, 151 Guangwen Street, Kuiwen District, Weifang city, Shandong Province, China.
Email: [email protected]
Search for more papers by this authorYunjie Li
School of Clinical Medicine, Weifang Medical University, Weifang, Shandong, China
Search for more papers by this authorYong Zhang
Department of Critical Care Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
Search for more papers by this authorRui Li
Department of Critical Care Medicine, Chongqing Kaizhou District People's Hospital, Kaizhou, Chongqing, China
Search for more papers by this authorMing Zhang
Department of Critical Care Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
Search for more papers by this authorCorresponding Author
Xiang Gao
Department of Critical Care Medicine, Weifang People's Hospital, Weifang, Shandong, China
Correspondence
Xiang Gao, 151 Guangwen Street, Kuiwen District, Weifang city, Shandong Province, China.
Email: [email protected]
Search for more papers by this authorYunjie Li and Yong Zhang contributed equally to this study and share the first authorship.
Abstract
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.
CONFLICT OF INTEREST
The authors hereby declare of having no conflicts of interest.
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