• Clin. Exp. Nephrol. · Aug 2017

    Review Meta Analysis

    Timing of initiation of renal replacement therapy for acute kidney injury: a systematic review and meta-analysis of randomized-controlled trials.

    • Yongxing Xu, Jianjun Gao, Xinming Zheng, Bo Zhong, Yu Na, and Jiamei Wei.
    • Department of Nephrology, The 306th Hospital of Chinese PLA, 9 AnXiangBeiLi Road, Beijing, People's Republic of China.
    • Clin. Exp. Nephrol. 2017 Aug 1; 21 (4): 552-562.

    BackgroundThe effects of early renal replacement therapy (RRT) on mortality and renal recovery in patients with acute kidney injury (AKI) remain controversial. A systematic review and meta-analysis of randomized-controlled trials (RCTs) was performed.MethodsMEDLINE, EMBASE and the Cochrane Library database (Cochrane Central Register of Controlled Trials) were searched to identify RCTs, investigating the effects of early RRT on patients with AKI.ResultsSix studies with a total of 1257 participants were included in this meta-analysis. Compared to late RRT, early RRT did not reduce the risk of mortality (RR 0.93, 95 % CI 0.68-1.26) or affect renal recovery (RR 0.88, 95 % CI 0.48-1.62) or composite endpoint (death or dialysis dependence) (RR 0.91, 95 % CI 0.71-1.17). There was no significant difference in adverse events in the analysis, between the early RRT and late RRT arms.ConclusionsEarly initiation of RRT for patients with AKI is not associated with decreased overall mortality or a delayed renal recovery rate. The optimal time to initiate RRT remains uncertain. Large scale and adequately powered RCTs are needed to detect the effects of early initiation of RRT in AKI patients.

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