Timing of renal replacement therapy for patients with acute kidney injury: a systematic review and meta-analysis

Andonovic, M., Shemilt, R., Sim, M., Traynor, J. P., Shaw, M., Mark, P. B. and Puxty, K. A. (2020) Timing of renal replacement therapy for patients with acute kidney injury: a systematic review and meta-analysis. Journal of the Intensive Care Society, (doi: 10.1177/1751143720901688) (Early Online Publication)

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Abstract

Background Acute kidney injury is associated with high mortality, and the optimal time to start renal replacement therapy for acute kidney injury is unknown despite several randomised controlled trials on the subject. We performed a systematic review and meta-analysis to assess the effect of earlier initiation of renal replacement therapy for acute kidney injury on mortality and reported secondary outcomes. Methods All literature in databases EMBASE, MEDLINE and CENTRAL was searched from January 1970 to March 2019 using terms related to renal replacement therapy, timing and randomised controlled trials. All randomised controlled trials with 25 or more adult participants suffering from acute kidney injury comparing timing of renal replacement therapy were included. The results of the selected studies were pooled and expressed in terms of risk ratios (RR) and 95% confidence intervals (95% CI) using a random effects model. Results A total of 7008 records were identified; 94 were selected for full text review of which 10 were included in the final meta-analysis. The 10 studies comprised 1956 participants (989 ‘early’ group; 967 ‘late’ group) with 918 total deaths; the analysis demonstrated no significant differences between the ‘early’ and ‘late’ renal replacement therapy groups (RR = 0.98 (95% CI = 0.84, 1.15)) for mortality. No significant differences between groups were evident for period-wise mortality; dialysis dependence; recovery of renal function; length of intensive care unit or hospital stay; or number of renal replacement therapies, mechanical ventilation and vasopressor-free days. Conclusions Current evidence does not support the use of early renal replacement therapy for patients with acute kidney injury. Data from ongoing and future randomised controlled trials are required to strengthen the evidence base in the area.

Item Type:Articles
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Shemilt, Dr Richard and Sim, Malcolm and Andonovic, Dr Mark and Mark, Dr Patrick and Puxty, Dr Kathryn and Shaw, Mr Martin and Traynor, Dr Jamie
Authors: Andonovic, M., Shemilt, R., Sim, M., Traynor, J. P., Shaw, M., Mark, P. B., and Puxty, K. A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of the Intensive Care Society
Publisher:SAGE Publications
ISSN:1751-1437
ISSN (Online):2057-360X
Published Online:06 February 2020

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