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2016 ; 95
(46
): e5434
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Early initiation of renal replacement treatment in patients with acute kidney
injury: A systematic review and meta-analysis
#MMPMID27861388
Wang H
; Li L
; Chu Q
; Wang Y
; Li Z
; Zhang W
; Li L
; He L
; Ai Y
Medicine (Baltimore)
2016[Nov]; 95
(46
): e5434
PMID27861388
show ga
BACKGROUND: Acute kidney injury (AKI) is associated with a substantially
increased risk of mortality for many hospitalized patients. It has been suggested
that early initiation of renal replacement treatment has a favorable outcome in
critically ill patients complicated with AKI. However, results of studies
evaluating the effect of early initiation strategy of renal replacement treatment
on AKI have been controversial and contradictory. The aim of this meta-analysis
is to examine the effect of early initiation of renal replacement treatment on
patients with AKI. METHODS: The authors searched relevant studies in PubMed,
EMBASE, and the Cochrane Library through August 2016. We searched for all
eligible randomized controlled trials with regard to the role of early initiation
of renal replacement treatment in mortality among patients with AKI. We extracted
the following information from each study: mortality, length of stay in intensive
care unit (ICU), and length of stay in hospital. Random and fixed effect models
were used for pooling data. RESULTS: Twelve trials including 1756 patients were
included. The results of this meta-analysis showed that there was no significant
difference between the mortality of early and delayed strategy for the initiation
of renal replacement treatment using the random effect model (odds ratio?=?0.78;
95% confidence interval [CI], 0.52-1.19; P?=?0.25), with wild heterogeneity
(chi?=?33.50; I?=?67%). Analyses from subgroup sepsis and postsurgery came to
similar results. In addition, compared with delayed initiation strategy, early
initiation showed no significant advantage in length of stay in ICU (mean
difference = -0.80; 95% CI, -2.59 to 0.99; P?=?0.56) and length of stay in
hospital (mean difference = -7.69; 95% CI, -16.14 to 0.76; P?=?0.07). CONCLUSION:
According to the results from present meta-analysis, early initiation of renal
replacement treatment showed no survival benefits in patients with AKI. To
achieve optimal timing of renal replacement treatment, further large multicenter
randomized trials, with widely accepted and standardized definition of early
initiation, are still needed.
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