Early versus late initiation of renal replacement therapy for acute kidney injury in critically ill patients: A systematic review and meta-analysis

Autoři: Li Xiao aff001;  Lu Jia aff002;  Rongshan Li aff002;  Yu Zhang aff003;  Hongming Ji aff002;  Andrew Faramand aff004
Působiště autorů: Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China,Chengdu, Sichuan, China aff001;  Shanxi Provincial People’s Hospital, Taiyuan, China aff002;  Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China aff003;  University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0223493



Acute kidney injury is associated with high mortality, and is the most frequent complication encountered in patients residing in the intensive care unit. Although renal replacement therapy (RRT) is the standard of care for acute kidney injury, the optimal timing for initiation is still unknown.


We conducted a systemic review and meta-analysis of randomized controlled trials evaluating early versus late initiation of RRT in critically ill patients with acute kidney injury. We searched MEDLINE, Embase, and CENTRAL databases from inception to October 15, 2018. We screened studies and extracted data from published reported independently. The primary outcome was short-term mortality.


A total of 2242 patients were included from 11 trials. No statistically significant effect was found for early versus late initiation of RRT on short-term mortality (risk ratio [RR] 0.99, 95% CI 0.84–1.17, p = 0.93) or long-term mortality (RR 0.98, 95% CI 0.85–1.13, p = 0.76). There were also no statistically significant effects on ICU length of stay, hospital length of stay, recovery of renal function, and renal replacement therapy dependence. Early initiation of RRT decreased the risk of metabolic acidosis (RR 0.65, 95% CI 0.43–0.99, p = 0.04), but increased the risk of hypotension (RR 1.24, 95% CI 1.08–1.43, p = 0.003).


In critically ill patients with acute kidney injury, early compared with late initiation of RRT is not associated with favorable mortality outcomes, although it appears to reduce the risk of metabolic acidosis.

Klíčová slova:

Cardiology – Death rates – Hypotension – Intensive care units – Kidneys – Renal system – Acidosis


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2019 Číslo 10
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