Timing of initiation of renal replacement therapy in acute kidney injury: an updated meta-analysis of randomized controlled trials.
Ren Fail
; 42(1): 77-88, 2020 Nov.
Article
em En
| MEDLINE
| ID: mdl-31893969
ABSTRACT
Purpose:
The results from randomized controlled trials (RCTs) concerning the timing of initiation of renal replacement therapy (RRT) for patients with acute kidney injury (AKI) are still inconsistent.Materials andmethods:
We searched for RCTs, as well as relevant references, focusing on the timing of RRT for AKI patients in the Medline, Embase, Cochrane Library, Google Scholar and Chinese databases from their inception to December 2018.Results:
We included 18 RCTs from 1997 to 2018 involving 2856 patients. Pooled analyses of all RCTs showed no significant difference in mortality between early initiation and delayed initiation of RRT (RR 0.98, 95% CI 0.89 to 1.08, p = .7) (I2 = 2%), and similar results were found in critically ill and community-acquired AKI patients, as well as in a subgroup of patients with sepsis and in cardiac surgery recipients. There was also no difference in the incidence of dialysis independence (RR 0.75, 95% CI 0.47 to 1.2, p = .2) (I2 = 0). However, an early RRT strategy was associated with a significantly higher incidence of the need for RRT for AKI patients (RR 1.24, 95% CI 1.13 to 1.36, p < .01) (I2 = 34%).Conclusions:
As no life-threatening complications occurred, there was no evidence to show any benefit of an early RRT strategy for critically ill or community-acquired AKI patients; in contrast, a delayed strategy might avert the need for RRT.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Terapia de Substituição Renal
/
Injúria Renal Aguda
/
Tempo para o Tratamento
Tipo de estudo:
Clinical_trials
/
Guideline
/
Incidence_studies
/
Prognostic_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
Ren Fail
Assunto da revista:
NEFROLOGIA
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
China