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

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.

Acute kidney injury: Epidemiology, outcomes, complications, and therapeutic strategies

“…Despite previous studies investigating the relationship between mortality and the timing of RRT initiation, it remained controversial whether early initiation of RRT improved outcomes. In 2016, two RCTs and in 2017 nine systematic reviews and meta‐analyses evaluated the optimal timing of RRT initiation for AKI. A multicenter RCT study, the Artificial Kidney Initiation in Kidney Injury (AKIKI) study, conducted in France, showed that there were no significant differences in mortality between early and late initiation of RRT .…”

“…Early initiation of RRT (defined as KDIGO stage 3 AKI) in the AKIKI study corresponded to the delayed arm in the ELAIN study. Turning to the conclusions of nine meta-analyses,[90][91][92][93][94][95][96][97][98] the AKI patients in the RCTs who underwent early initiation of RRT did not show a lower mortality rate than those with late RRT [90][91][92][93][94]96,98.…”