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Accelerated versus watchful waiting strategy of kidney replacement therapy for acute kidney injury: a systematic review and meta-analysis of randomized clinical trials.
Chen, Jui-Yi; Chen, Ying-Ying; Pan, Heng-Chih; Hsieh, Chih-Chieh; Hsu, Tsuen-Wei; Huang, Yun-Ting; Huang, Tao-Min; Shiao, Chih-Chung; Huang, Chun-Te; Kashani, Kianoush; Wu, Vin-Cent.
Afiliação
  • Chen JY; Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
  • Chen YY; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
  • Pan HC; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
  • Hsieh CC; Division of Nephrology, Department of Internal Medicine, Pingtung Christian Hospital, Pingtung, Taiwan.
  • Hsu TW; Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
  • Huang YT; Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
  • Huang TM; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
  • Shiao CC; Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary's Hospital Luodong; and Saint Mary's Medicine, Nursing and Management College, 160 Chong-Cheng South Road, Luodong, Yilan, Taiwan.
  • Huang CT; Nephrology and Critical Care Medicine, Department of Internal Medicine and Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
  • Kashani K; Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
  • Wu VC; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Clin Kidney J ; 15(5): 974-984, 2022 May.
Article em En | MEDLINE | ID: mdl-35498901
Background: Critically ill patients with severe acute kidney injury (AKI) requiring kidney replacement therapy (KRT) have a grim prognosis. Recently, multiple studies focused on the impact of KRT initiation time [i.e., accelerated versus watchful waiting KRT initiation (WWS-KRT)] on patient outcomes. We aim to review the results of all related clinical trials. Methods: In this systematic review, we searched all relevant randomized clinical trials from January 2000 to April 2021. We assessed the impacts of accelerated versus WWS-KRT on KRT dependence, KRT-free days, mortality and adverse events, including hypotension, infection, arrhythmia and bleeding. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. Results: A total of 4932 critically ill patients with AKI from 10 randomized clinical trials were included in this analysis. The overall 28-day mortality rate was 38.5%. The 28-day KRT-dependence rate was 13.0%. The overall incident of KRT in the accelerated group was 97.4% and 62.8% in the WWS-KRT group. KRT in the accelerated group started 36.7 h earlier than the WWS-KRT group. The two groups had similar risks of 28-day [pooled log odds ratio (OR) 1.001, P = 0.982] and 90-day (OR 0.999, P = 0.991) mortality rates. The accelerated group had a significantly higher risk of 90-day KRT dependence (OR 1.589, P = 0.007), hypotension (OR 1.687, P < 0.001) and infection (OR 1.38, P = 0.04) compared with the WWS-KRT group. Conclusions: This meta-analysis revealed that accelerated KRT leads to a higher probability of 90-day KRT dependence and dialysis-related complications without any impact on mortality rate when compared with WWS-KRT. Therefore, we suggest the WWS-KRT strategy for critically ill patients.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Clinical_trials / Systematic_reviews Idioma: En Revista: Clin Kidney J Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Clinical_trials / Systematic_reviews Idioma: En Revista: Clin Kidney J Ano de publicação: 2022 Tipo de documento: Article