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Table 2 Comparisons of meta-analyses evaluating timing of RRT initiation in AKI and patients outcomes

From: Earlier versus later initiation of renal replacement therapy among critically ill patients with acute kidney injury: a systematic review and meta-analysis of randomized controlled trials

  Population setting Enrolled studies Outcomes Results (benefit of early RRT) Limitations
Current study Mixed patients with AKI (n = 1627) Total nine RCTs. (publication date: 2002–2016) In-hospital mortality; RRT dependence, 30-, 60-, 90-day mortality after hospital discharge All: no significant advantage in survival (in-hospital, 30-, 60-, 90-day mortality) and RRT dependence
Subgroups: Significant survival benefit in surgical patients and those started with CRRT
High heterogeneity among studies, varied definitions of early RRT
Seabra [41] Mixed patients with AKI (n = 2378) Total 23 studies including 4 RCTs, 1 quasi-RCTs, 1 prospective study, 16 retrospective studies, and 1 single-arm study (publication date: 1961–2006) Mortality RCTs nonsignificant 36% reduction of mortality risk
Cohort studies significant 28% reduction of mortality risk (with significant heterogeneity among cohort studies)
Subgroups smaller studies (n < 100) were more likely to show the benefit of early RRT
Paucity of RCTs, varied definitions of early RRT, many small sized studies, publications bias
Karvellas [26] Mixed patients with AKI (n = 2684) Total 15 studies including 2 RCTs, 4 prospective studies, and 9 retrospective studies (publication period: 1999–2010) 28-day mortality All significant 55% reduction of mortality risk (with significant heterogeneity)
Subgroups survival benefit remains in subgroup analysis according to ICU type, study design, and illness severity
Varied quality and high heterogeneity among studies Some studies were of small sample size Diverse definitions of early vs late RRT
Wang [42] Mixed patients with AKI (n = 2955) About 50% studies involved surgical patients Total 15 studies including 3 RCTs, 2 prospective studies, and 10 retrospective studies (publication period: 1990–2011) Mortality All significant 29% reduction of mortality risk (with high heterogeneity)
Subgroups significant reduction of mortality risk of 31% in CRRT and 74% in IHD (without evidence of heterogeneity)
Many studies were of relative low quality, small sample size, diverse definitions of early vs late RRT
Liu [45] Surgical patients with AKI (after cardiac surgery) (n = 841) Total 11 studies including 2 RCTs and 9 retrospective studies (publication period: 1972–2011) 28-day mortality; ICU LOS Significant 71% reduction of 28-day mortality risk and 3.9 days shorter ICU LOS (with high heterogeneity among studies) Based on studies with various quality with very high heterogeneity of results
Wierstra [24] Mixed patients with AKI (n = 1042) Total nine high-quality studies including 6 RCTs, 1 prospective study, and 2 retrospective studies (publication period: 2002–2015) 1-month mortality; ICU/hospital LOS All no significant advantage in survival and ICU/hospital LOS
Subgroups no advantage in survival and ICU/hospital LOS
Statistically significant heterogeneity among studies Diverse definitions of early vs late RRT
Xu [25] Mixed patients with AKI (n = 1257) Total six RCTs (publication period: 2002–2016) Mortality, renal recovery, composite endpoint No difference in mortality, renal recovery, composite endpoint Insufficient number of studies included, some RCTs were relatively small, diverse definitions of early vs late RRT
  1. AKI acute kidney injury, CRRT continuous renal replacement therapy, ICU intensive care unit; IHD intermittent hemodialysis, LOS length of stay, RCT randomized controlled trial
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