Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/26240
Title: Time to Initiation of Renal Replacement Therapy Among Critically Ill Patients With Acute Kidney Injury: A Current Systematic Review and Meta-Analysis.
Austin Authors: Naorungroj, Thummaporn ;Serpa Neto, Ary ;Yanase, Fumitaka ;Eastwood, Glenn M ;Wald, Ron;Bagshaw, Sean M;Bellomo, Rinaldo 
Affiliation: Intensive Care
Department of Intensive Care, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands
ANZICS-Research Centre, Monash University Division and School of Public Health and Preventive Medicine, Melbourne, VIC, Australia
Data Analytics Research and Evaluation (DARE) Centre
Division of Nephrology, Department of Medicine, St. Michael's Hospital and the University of Toronto, Toronto, ON, Canada
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
Centre for Integrated Critical Care, Department of Medicine and Radiology, The University of Melbourne, Melbourne, VIC, Australia
Issue Date: 5-Apr-2021
metadata.dc.date: 2021-04-05
Publication information: Critical Care Medicine 2021; online first: 5 April
Abstract: The optimal time to initiate renal replacement therapy in critically ill patients with acute kidney injury is controversial. We investigated the effect of such earlier versus later initiation of renal replacement therapy on the primary outcome of 28-day mortality and other patient-centered secondary outcomes. We searched MEDLINE (via PubMed), EMBASE, and Cochrane databases to July 17, 2020, and included randomized controlled trials comparing earlier versus later renal replacement therapy. Multiple centers involved in eight trials. Total of 4,588 trial participants. Two independents investigators screened and extracted data using a predefined form. We selected randomized controlled trials in critically ill adult patients with acute kidney injury and compared of earlier versus later initiation of renal replacement therapy regardless of modality. Overall, 28-day mortality was similar between earlier and later renal replacement therapy initiation (38.43% vs 38.06%, respectively; risk ratio, 1.01; [95% CI, 0.94-1.09]; I = 0%). Earlier renal replacement therapy, however, shortened hospital length of stay (mean difference, -2.14 d; [95% CI, -4.13 to -0.14]) and ICU length of stay (mean difference, -1.18 d; [95% CI, -1.95 to -0.42]). In contrast, later renal replacement therapy decreased the use of renal replacement therapy (relative risk, 0.69; [95% CI, 0.58-0.82]) and lowered the risk of catheter-related blood stream infection (risk ratio, 0.50, [95% CI, 0.29-0.86). Among survivors, renal replacement therapy dependence at day 28 was similar between earlier and later renal replacement therapy initiation (risk ratio, 0.98; [95% CI, 0.66-1.40]). Earlier or later initiation of renal replacement therapy did not affect mortality. However, earlier renal replacement therapy was associated with significantly shorter ICU and hospital length of stay, whereas later renal replacement therapy was associated with decreased use of renal replacement therapy and decreased risk of catheter-related blood stream infection. These findings can be used to guide the management of critically ill patients with acute kidney injury.
URI: https://ahro.austin.org.au/austinjspui/handle/1/26240
DOI: 10.1097/CCM.0000000000005018
PubMed URL: 33861550
Type: Journal Article
Appears in Collections:Journal articles

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