The impact of 'early' versus 'late' initiation of renal replacement therapy in critical care patients with acute kidney injury: a systematic review and evidence synthesis
| Autor: | Glen W. Barrisford, Sameer S Kadri, Ximena Burbano, Benjamin T. Wierstra, Raymond L. C. Kao, Soha Alomar |
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| Jazyk: | angličtina |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Critical Illness 030232 urology & nephrology Subgroup analysis Critical Care and Intensive Care Medicine law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law medicine Intensive care units (ICUs) Humans Renal replacement therapy Prospective Studies Intensive care medicine Retrospective Studies Acute kidney injury (AKI) business.industry Research Acute kidney injury 030208 emergency & critical care medicine Acute Kidney Injury Length of Stay medicine.disease Intensive care unit Renal Replacement Therapy Meta-analysis Intensive Care Units Early Late Hemodialysis Renal replacement therapy (RRT) business Evidence synthesis |
| Zdroj: | Critical Care |
| ISSN: | 1364-8535 |
| DOI: | 10.1186/s13054-016-1291-8 |
| Popis: | Background The optimal timing of initiating renal replacement therapy (RRT) in critical illness complicated by acute kidney injury (AKI) is not clearly established. Trials completed on this topic have been marked by contradictory findings as well as quality and heterogeneity issues. Our goal was to perform a synthesis of the evidence regarding the impact of “early” versus “late” RRT in critically ill patients with AKI, focusing on the highest-quality research on this topic. Methods A literature search using the PubMed and Embase databases was completed to identify studies involving critically ill adult patients with AKI who received hemodialysis according to “early” versus “late”/“standard” criteria. The highest-quality studies were selected for meta-analysis. The primary outcome of interest was mortality at 1 month (composite of 28- and 30-day mortality). Secondary outcomes evaluated included intensive care unit (ICU) and hospital length of stay (LOS). Results Thirty-six studies (seven randomized controlled trials, ten prospective cohorts, and nineteen retrospective cohorts) were identified for detailed evaluation. Nine studies involving 1042 patients were considered to be of high quality and were included for quantitative analysis. No survival advantage was found with “early” RRT among high-quality studies with an OR of 0.665 (95 % CI 0.384–1.153, p = 0.146). Subgroup analysis by reason for ICU admission (surgical/medical) or definition of “early” (time/biochemical) showed no evidence of survival advantage. No significant differences were observed in ICU or hospital LOS among high-quality studies. Conclusions Our conclusion based on this evidence synthesis is that “early” initiation of RRT in critical illness complicated by AKI does not improve patient survival or confer reductions in ICU or hospital LOS. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1291-8) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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