title: Initiation time of renal replacement therapy on patients with acute kidney injury: A systematic review and meta-analysis of 8179 participants.
abstract: The early initiation of renal replacement therapy has been recommended for patients with acute renal failure by some studies, but its effects on mortality and renal recovery are unknown. We conducted an updated meta-analysis to provide quantitative evaluations of the association between the early initiation of renal replacement therapy and mortality for patients with acute kidney injury. After applying inclusion/exclusion criteria, 51 studies, including 10 randomized controlled trials, with a total of 8179 patients were analyzed. Analysis of the included trials showed that patients receiving early renal replacement therapy had a 25% reduction in all-cause mortality compared to those receiving late renal replacement therapy (risk ratio [RR] 0.75, 95% CI [0.69, 0.82]). We also noted a 30% increase in renal recovery (RR 1.30, 95% CI [1.07, 1.56]), a reduction in hospitalization of 5.84 days (mean difference [MD], 95% CI [-10.27, -1.41]) and a reduction in the duration of mechanical ventilation of 2.33 days (MD, 95% CI [-3.40, -1.26]) in patients assigned to early renal replacement therapy. The early initiation of renal replacement therapy was associated with a decreased risk of all-cause mortality compared with the late initiation of RRT in patients with acute kidney injury. These findings should be interpreted with caution given the heterogeneity between studies. Further studies are needed to identify the causes of mortality and to assess whether mortality differs by dialysis dose.
authors: Department of Nephrology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors: Caixia
authors: C
authors: Wang
authors: Operation Room, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors: Lin-Sheng
authors: LS
authors: Lv
authors: Department of Cardiology, Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
authors: Hui
authors: H
authors: Huang
authors: Department of Anesthesiology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors: Jianqiang
authors: J
authors: Guan
authors: Department of Nephrology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors: Zengchun
authors: Z
authors: Ye
authors: Department of Nephrology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors: Shaomin
authors: S
authors: Li
authors: Department of Nephrology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors: Yanni
authors: Y
authors: Wang
authors: Department of Nephrology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors: Tanqi
authors: T
authors: Lou
authors: Department of Nephrology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors: Xun
authors: X
authors: Liu
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D020127:Recovery of Function; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult
keywords: acute kidney injury; initiation time; meta-analysis; mortality; renal replacement therapy