• Thummaporn Naorungroj, NetoAry SerpaASDepartment of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.Department of Intensive Care, Academic Medical Center, Amsterdam, The Nethe, Fumitaka Yanase, Glenn Eastwood, Ron Wald, Sean M Bagshaw, and Rinaldo Bellomo.
• Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
• Crit. Care Med. 2021 Aug 1; 49 (8): e781e792e781-e792.

ObjectivesThe 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.DesignWe searched MEDLINE (via PubMed), EMBASE, and Cochrane databases to July 17, 2020, and included randomized controlled trials comparing earlier versus later renal replacement therapy.SettingMultiple centers involved in eight trials.PatientsTotal of 4,588 trial participants.InterventionTwo 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.Measurements And Main ResultsOverall, 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]; I2 = 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]).ConclusionsEarlier 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.Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

17 keywords...

hide…