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 |