title: Timing of initiation of renal replacement therapy for acute kidney injury: a systematic review and meta-analysis of randomized-controlled trials.
abstract: BACKGROUND
  The 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.
  
  
  METHODS
  MEDLINE, 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.
  
  
  RESULTS
  Six 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.
  
  
  CONCLUSIONS
  Early 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.
authors.affiliation: Department of Nephrology, The 306th Hospital of Chinese PLA, 9 AnXiangBeiLi Road, Beijing, People's Republic of China.
authors.forename: Yongxing
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Nephrology, The 306th Hospital of Chinese PLA, 9 AnXiangBeiLi Road, Beijing, People's Republic of China.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Gao
authors.affiliation: Clinical College of the 306th Hospital of Chinese PLA, AnHui Medical University, Hefei, People's Republic of China.
authors.forename: Xinming
authors.initials: X
authors.lastname: Zheng
authors.affiliation: Department of Nephrology, The 306th Hospital of Chinese PLA, 9 AnXiangBeiLi Road, Beijing, People's Republic of China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhong
authors.affiliation: Department of Nephrology, The 306th Hospital of Chinese PLA, 9 AnXiangBeiLi Road, Beijing, People's Republic of China. nayu306@163.com.
authors.forename: Yu
authors.initials: Y
authors.lastname: Na
authors.affiliation: Department of Nephrology, The 306th Hospital of Chinese PLA, 9 AnXiangBeiLi Road, Beijing, People's Republic of China.
authors.forename: Jiamei
authors.initials: J
authors.lastname: Wei
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Acute kidney injury; Meta-analysis; Randomized-controlled trials; Renal replacement therapy; Timing