Timing for initiation of continuous renal replacement therapy in patients with septic shock and acute kidney injury

Shum, HP; Chan, KL; Kwan, MC; Yeung, WT; Cheung, WS; Wu, Yan

doi:10.1186/cc10968

Cited by 9 publications

(23 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This prospective study described effects of decision-making in initiating dialysis in ICU patients with AKI, taking into consideration patients' illness severity, presence of oliguria and associated non-renal organ failure as recommended by Bagshaw et al and Ostermann et al 13,25 In particular, urine output criterion was included in determining AKIN stages, unlike other studies evaluating creatinine-only or eGFR-only RIFLE or AKIN criteria. 23,26 Patients who started ARRT in the presence of traditional indications had a greater risk of mortality, even after adjusting for their higher SOFA scores and increased need for respiratory and haemodynamic support. Severe azotaemia may contribute to sustained inflammatory response that compounds concurrent illness such as sepsis, and severe acidosis and electrolyte derangements may predispose to arrhythmias and sudden death.…”

Section: Discussionmentioning

confidence: 99%

“…This concurred with recent studies evaluating creatinine-based or RIFLE-based criteria for earlier ARRT initiation that failed to demonstrate survival benefit. 26,28,29 Jamale et al randomized 208 patients with community-acquired AKI (excluding those with uraemic complications and treatment-refractory metabolic acidosis and hyperkalaemia) to early ARRT initiation when BUN exceeded 70 mg/dL or serum creatinine exceeded 7 mg/dL compared with initiation decided by nephrologists. 28 Patients who started ARRT in the 'early' group had lower mean BUN and creatinine compared with the control group (71.7 vs 100.9 mg/dL; 7.4 vs 10.4 mg/dL), but earlier dialysis therapy before onset of uraemic complications did not improve survival.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Initiating acute dialysis at earlier Acute Kidney Injury Network stage in critically ill patients without traditional indications does not improve outcome: A prospective cohort study

et al. 2015

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Initiating acute dialysis at earlier Acute Kidney Injury Network stage in critically ill patients without traditional indications does not improve outcome: A prospective cohort study

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Nine studies [20,[24][25][26][27][28][29][30][31] with a total of 1694 patients ultimately met our criteria (Table 1). These references included two RCTs [20,24] and seven retrospective cohort studies [25][26][27][28][29][30][31]. The characteristics and methodological quality of all trials in the meta-analysis are shown in Table 1 and the outcomes in septic patients with AKI are shown in Table 2.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

Early versus late initiation of renal replacement therapy impacts mortality in septic patients with acute kidney injury: a meta-analysis

Ge¹,

Jiang²,

Peng³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Acute kidney injury (AKI) is a frequent complication in septic patients and increases in-hospital mortality. Our aim was to evaluate the impact of early versus late initiation of renal replacement therapy (RRT) on clinical outcomes in septic patients with acute kidney injury (AKI). Methods: Systematic review and meta-analysis were used in this study. We searched PubMed, EMBASE, MEDLINE and Cochrane Library. Results: Nine studies (two randomized controlled trials (RCTs) and seven retrospective cohorts) including 1694 patients were identified for detailed evaluation. This meta-analysis suggested that early RRT initiation within 48 hours (OR 0.30; 95% CI 0.20 to 0.45; I 2 0%) in septic patients with AKI reduced 28-day mortality (odds ratio (OR) 0.56; 95% confidence interval (CI) 0.37 to 0.86; I 2 73%), but intensive care unit (ICU) length of stay (LOS) (mean difference (MD) -1.49; 95% CI -3.65 to -0.67; I 2 53%), hospital LOS (MD -3.18; 95% CI -7.35 to 0.99; I 2 41%), the duration of RRT (MD -2.05; 95%CI -6.86 to 2.76; I 2 83%) and the duration of ventilation (MD 1.99; 95%CI -2.76 to 6.75; I 2 85%) were not influenced by the timing of RRT initiation. Conclusions: Early initiation of RRT within 48 hours in septic patients with AKI may have a beneficial impact on survival. However, this conclusion is based on heterogeneous trials of different quality and only two RCTs. Conclusive therapeutic recommendations regarding the optimal time to initiate RRT remain uncertain.

show abstract

“…As there have been many advances in the management of patients with AKI, since dialysis was first introduced as a treatment for AKI, 3,4 we have restricted review to trials published from 2006 ( Table 2). [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Eleven observational reports suggested a beneficial effect for earlier initiation of RRT. On the other hand, five retrospective studies showed no benefit as did one recent prospective study.…”

Section: Observational Studies Of Earlier Initiation Of Dialysis For Akimentioning

confidence: 99%

Early start renal replacement therapy for acute kidney injury—Universal panacea or another case of over medicalization?

Davenport

2015

Hemodialysis International

View full text Add to dashboard Cite

Despite advances in medical practice and renal replacement therapy, the mortality of patients who develop acute kidney injury remains high. In the field of cardiology, the management of myocardial infarction has evolved from one of conservative bed rest to primary coronary intervention. As renal replacement therapy is now generally available, the question arises whether earlier intervention could lead to improved patient outcomes. The evidence to date is primarily centered on retrospective observational reports, with the majority reporting increased patient survival for earlier intervention. However, these reports are typically based on small numbers of patients and differ in the etiology of acute kidney injury, patient comorbidity, and definitions of what constitutes "early" start. To date, there is less than a handful of prospective randomized studies published in the modern era. Again these are small studies, with differing patient populations, and definitions of "early" start, but generally do not show any significant advantage for an "early" start approach. As such until adequately powered prospective trial data become available, the decision to initiate renal replacement therapy should be made by the traditional review of patient history, repeated clinical assessments, and trends in biochemical data.

show abstract

Timing for initiation of continuous renal replacement therapy in patients with septic shock and acute kidney injury

Cited by 9 publications

References 0 publications

Initiating acute dialysis at earlier Acute Kidney Injury Network stage in critically ill patients without traditional indications does not improve outcome: A prospective cohort study

Initiating acute dialysis at earlier Acute Kidney Injury Network stage in critically ill patients without traditional indications does not improve outcome: A prospective cohort study

Early versus late initiation of renal replacement therapy impacts mortality in septic patients with acute kidney injury: a meta-analysis

Early start renal replacement therapy for acute kidney injury—Universal panacea or another case of over medicalization?

Contact Info

Product

Resources

About