Timing of initiation of renal replacement therapy for patients with acute kidney injury: A meta-analysis of RCTs

Purpose: To assess the effects of delayed versus early renal replacement therapy (RRT) initiation for patients with AKI.

Methods: Related RCTs of RRT initiated at different times published on PubMed, Web of Science, Embase, and Cochrane Library were searched.

Results: Fifteen RCTs studies with 5395 patients were included. The results showed that the 28-day mortality (RR 1.01; 95% CI 0.94 ~ 1.08; p = 0.80), 60-day mortality (RR 1.00; 95% CI 0.91 ~ 1.11; p = 0.93), 90-day mortality (RR 1.01; 95% CI 0.94 ~ 1.08; p = 0.80), dialysis dependence among survivors (RR 0.67; 95% CI 0.40 ~ 1.13; p = 0.13), length of ICU stay (RR -1.32; 95% CI -3.26 ~ 0.62; p = 0.18) and length of hospital stay among survivors(RR -0.98; 95% CI -2.89 ~ 0.92; p = 0.31) were not significantly different between the two groups. In addition, early initiation of RRT increases the incidence of hypotension (RR 1.42, 95% CI 1.23 ~ 1.63; p < 0.00001) and infectious (RR 1.36; 95% CI 1.03 ~ 1.80; p = 0.03) events.

Conclusion: Early initiation of RRT cannot improve the prognosis and benefit patients.