Disease Severity Determines Timing of Initiating Continuous Renal Replacement Therapies: A Systematic Review and Meta-Analysis

Background: Timing of initiating continuous renal replacement therapies (CRRTs) among the patients with acute kidney injury (AKI) in intensive care units (ICU) has been discussed over decades, but the definition of early and late CRRT initiation is still unclear.Methods: The English language randomi...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Zi-Jing Xia, Lin-ye He, Shu-Yue Pan, Rui-Juan Cheng, Qiu-Ping Zhang, Yi Liu
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	continuous renal replacement therapies CRRT timing acute kidney injury AKI Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/59c3819df5634061b1b80ad10ffeeb88
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:59c3819df5634061b1b80ad10ffeeb88
record_format	dspace
spelling	oai:doaj.org-article:59c3819df5634061b1b80ad10ffeeb882021-11-18T05:54:54ZDisease Severity Determines Timing of Initiating Continuous Renal Replacement Therapies: A Systematic Review and Meta-Analysis2296-858X10.3389/fmed.2021.580144https://doaj.org/article/59c3819df5634061b1b80ad10ffeeb882021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.580144/fullhttps://doaj.org/toc/2296-858XBackground: Timing of initiating continuous renal replacement therapies (CRRTs) among the patients with acute kidney injury (AKI) in intensive care units (ICU) has been discussed over decades, but the definition of early and late CRRT initiation is still unclear.Methods: The English language randomized controlled trials (RCTs) and cohort studies were searched through MEDLINE, EMBASE, and Cochrane Library on July 19, 2019, by the two researchers independently. The study characteristics; early and late definitions; outcomes, such as all-cause, in-hospital, 28- or 30-, 60-, 90-day mortality; and renal recovery were extracted from the 18 eligible studies. Pooled relative risk ratios (RRs) and 95% CIs were estimated with the fixed effects model and random effects model as appropriate. This study is registered with PROSPERO (CRD 42020158653).Results: Eighteen studies including 3,914 patients showed benefit in earlier CRRT (n = 1,882) over later CRRT (n = 2,032) in all-cause mortality (RR 0.78, 95% CI 0.66–0.92), in-hospital mortality (RR 0.81, 95% CI 0.67–0.99), and 28- or 30-day mortality (RR 0.81, 95% CI 0.74–0.88), but in 60- and 90-day mortalities, no significant benefit was observed. The subgroup analysis showed significant benefit in the disease-severity-based subgroups on early CRRT initiation in terms of in-hospital mortality and 28- or 30-day mortality rather than the time-based subgroups. Moreover, early CRRT was found to have beneficial effects on renal recovery after CRRT (RR 1.21, 95% CI 1.01–1.45).Conclusions: Overall, compared with late CRRT, early CRRT is beneficial for short-term survival and renal recovery, especially when the timing was defined based on the disease severity. CRRT initiation on Acute Kidney Injury Network (AKIN) stage 1 or Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE)-Risk or less may lead to a better prognosis.Zi-Jing XiaLin-ye HeShu-Yue PanShu-Yue PanRui-Juan ChengQiu-Ping ZhangYi LiuFrontiers Media S.A.articlecontinuous renal replacement therapiesCRRTtimingacute kidney injuryAKIMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	continuous renal replacement therapies CRRT timing acute kidney injury AKI Medicine (General) R5-920
spellingShingle	continuous renal replacement therapies CRRT timing acute kidney injury AKI Medicine (General) R5-920 Zi-Jing Xia Lin-ye He Shu-Yue Pan Shu-Yue Pan Rui-Juan Cheng Qiu-Ping Zhang Yi Liu Disease Severity Determines Timing of Initiating Continuous Renal Replacement Therapies: A Systematic Review and Meta-Analysis
description	Background: Timing of initiating continuous renal replacement therapies (CRRTs) among the patients with acute kidney injury (AKI) in intensive care units (ICU) has been discussed over decades, but the definition of early and late CRRT initiation is still unclear.Methods: The English language randomized controlled trials (RCTs) and cohort studies were searched through MEDLINE, EMBASE, and Cochrane Library on July 19, 2019, by the two researchers independently. The study characteristics; early and late definitions; outcomes, such as all-cause, in-hospital, 28- or 30-, 60-, 90-day mortality; and renal recovery were extracted from the 18 eligible studies. Pooled relative risk ratios (RRs) and 95% CIs were estimated with the fixed effects model and random effects model as appropriate. This study is registered with PROSPERO (CRD 42020158653).Results: Eighteen studies including 3,914 patients showed benefit in earlier CRRT (n = 1,882) over later CRRT (n = 2,032) in all-cause mortality (RR 0.78, 95% CI 0.66–0.92), in-hospital mortality (RR 0.81, 95% CI 0.67–0.99), and 28- or 30-day mortality (RR 0.81, 95% CI 0.74–0.88), but in 60- and 90-day mortalities, no significant benefit was observed. The subgroup analysis showed significant benefit in the disease-severity-based subgroups on early CRRT initiation in terms of in-hospital mortality and 28- or 30-day mortality rather than the time-based subgroups. Moreover, early CRRT was found to have beneficial effects on renal recovery after CRRT (RR 1.21, 95% CI 1.01–1.45).Conclusions: Overall, compared with late CRRT, early CRRT is beneficial for short-term survival and renal recovery, especially when the timing was defined based on the disease severity. CRRT initiation on Acute Kidney Injury Network (AKIN) stage 1 or Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE)-Risk or less may lead to a better prognosis.
format	article
author	Zi-Jing Xia Lin-ye He Shu-Yue Pan Shu-Yue Pan Rui-Juan Cheng Qiu-Ping Zhang Yi Liu
author_facet	Zi-Jing Xia Lin-ye He Shu-Yue Pan Shu-Yue Pan Rui-Juan Cheng Qiu-Ping Zhang Yi Liu
author_sort	Zi-Jing Xia
title	Disease Severity Determines Timing of Initiating Continuous Renal Replacement Therapies: A Systematic Review and Meta-Analysis
title_short	Disease Severity Determines Timing of Initiating Continuous Renal Replacement Therapies: A Systematic Review and Meta-Analysis
title_full	Disease Severity Determines Timing of Initiating Continuous Renal Replacement Therapies: A Systematic Review and Meta-Analysis
title_fullStr	Disease Severity Determines Timing of Initiating Continuous Renal Replacement Therapies: A Systematic Review and Meta-Analysis
title_full_unstemmed	Disease Severity Determines Timing of Initiating Continuous Renal Replacement Therapies: A Systematic Review and Meta-Analysis
title_sort	disease severity determines timing of initiating continuous renal replacement therapies: a systematic review and meta-analysis
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/59c3819df5634061b1b80ad10ffeeb88
work_keys_str_mv	AT zijingxia diseaseseveritydeterminestimingofinitiatingcontinuousrenalreplacementtherapiesasystematicreviewandmetaanalysis AT linyehe diseaseseveritydeterminestimingofinitiatingcontinuousrenalreplacementtherapiesasystematicreviewandmetaanalysis AT shuyuepan diseaseseveritydeterminestimingofinitiatingcontinuousrenalreplacementtherapiesasystematicreviewandmetaanalysis AT shuyuepan diseaseseveritydeterminestimingofinitiatingcontinuousrenalreplacementtherapiesasystematicreviewandmetaanalysis AT ruijuancheng diseaseseveritydeterminestimingofinitiatingcontinuousrenalreplacementtherapiesasystematicreviewandmetaanalysis AT qiupingzhang diseaseseveritydeterminestimingofinitiatingcontinuousrenalreplacementtherapiesasystematicreviewandmetaanalysis AT yiliu diseaseseveritydeterminestimingofinitiatingcontinuousrenalreplacementtherapiesasystematicreviewandmetaanalysis
_version_	1718424666517798912

Disease Severity Determines Timing of Initiating Continuous Renal Replacement Therapies: A Systematic Review and Meta-Analysis

Ejemplares similares