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2017 ; 12
(3
): e0174158
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gab.com Text
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English Wikipedia
The effect of early versus late initiation of renal replacement therapy in
patients with acute kidney injury: A meta-analysis with trial sequential analysis
of randomized controlled trials
#MMPMID28329026
Feng YM
; Yang Y
; Han XL
; Zhang F
; Wan D
; Guo R
PLoS One
2017[]; 12
(3
): e0174158
PMID28329026
show ga
BACKGROUND: The optimal timing for initiating renal replacement therapy (RRT) in
patients with acute kidney injury (AKI) remains controversial. METHODS: We
conducted a meta-analysis with trial sequential analysis (TSA) of randomized
controlled trials (RCTs) using PUBMED, Cochrane Library databases, and Web of
Science (from January 1, 1985, to August 21, 2016). Adult patients with AKI who
received RRT with different timing were included. The primary outcome was
mortality. The secondary outcomes were intensive care unit (ICU) length of stay
(LOS) and hospital LOS. RESULTS: We included 9 RCTs with a total of 1636
participants. No differences between the early RRT group and the late RRT group
were found with respect to mortality (38% vs 41.4%; relative risk, 0.93; 95%
confidence interval [CI], 0.74-1.18). However, TSA showed that the cumulative
Z-curve did not cross either the conventional boundary for benefit or the trial
sequential monitoring boundary, indicating insufficient evidence. Similarity,
there were no findings of benefits in terms of reduction in the ICU LOS (standard
difference in the means, -0.32 days; 95% CI, -0.71 to 0.07 days) and hospital LOS
(standard difference in the means, -1.11 days; 95% CI, -2.28 to 0.06 days).
Meanwhile, the results of TSA did not confirm this conclusion. CONCLUSIONS:
Although conventional meta-analysis showed that early initiation of RRT in
patients with AKI was not associated with decreased mortality, ICU LOS and
hospital LOS, TSA indicated that the data were far too sparse to make any
conclusions. Therefore, well-designed, large RCTs are needed.