Skip to main content

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