Treat severe acute kidney failure with renal replacement therapy in early or late stages-a Meta analysis

doi:10.3969/j.issn.1006-7795.2016.02.016

Abstract

Abstract: Objective To explore the impact of early versus late initiation of renal replacement therapy (RRT) on critically ill patients suffered from acute kidney injury (AKI). Methods Meta-analysis including effect combination, subgroup analysis and meta-regression were used in the present study. CNKI, WANFANG, Pubmed, EMBASE, SCOPUS and Web of Science (January 1985 to May 2015) were searched. Cohort and randomized trials that assessed timing of initiation of RRT in critically ill adults with AKI were considered eligible.Results Totally 15 unique studies with 2 randomized, 4 prospective cohort and 9 retrospective cohort studies out of 1 494 retrieved citations were identified. The general methodological quality was roughly low. Early, compared with late therapy, was associated with a significant improvement in 28-day mortality [odds ratio (OR)=0.45; 95% confidence interval (CI): 0.28 to 0.72, P<0.001]. There was significant heterogeneity among the 15 pooled studies (I²=78%). In subgroup analyses, stratification was done by (intensive care unit, ICU) modality or study design, there was no impact on the overall summary estimate for mortality. Early RRT did not; however, it significantly affected the odds of kidney recovery beyond hospitalization (OR=0.62, 95% CI: 0.34 to 1.13, I²=69.6%). Conclusion 1. Earlier institution of RRT in critically ill patients with AKI may have a significant beneficial impact on survival. 2. Merged evidence indicates such beneficial effect cannot be observed for the same population on renal function; 3. Current evidences are basically derived from small sample studies with varied designs and quality. Consequently, any findings about RRT timing cannot be conclusive until new evidence from large-sample, multi-center, sound-design trials have been conducted and reported; 4. Studies focusing on a standardized, plausible division between early and late stages of RRT may be particularly necessary.

Key words: acute kidney injury, extracorporeal renal replacement therapy, critically ill, mortality, kidney recovery, timing of initiation

CLC Number:

R692

Rong Guang, Hu Jiahui, Meng Qinggang, Xie Qingyu. Treat severe acute kidney failure with renal replacement therapy in early or late stages-a Meta analysis[J]. Journal of Capital Medical University, 2016, 37(2): 188-195.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2016.02.016

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2016/V37/I2/188

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