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Review
. 2017 Jun 17;21(1):150.
doi: 10.1186/s13054-017-1707-0.

Early versus late initiation of renal replacement therapy impacts mortality in patients with acute kidney injury post cardiac surgery: a meta-analysis

Honghong Zou  1   2 , Qianwen Hong  3 , Gaosi Xu  4
Affiliations
Review

Early versus late initiation of renal replacement therapy impacts mortality in patients with acute kidney injury post cardiac surgery: a meta-analysis

Honghong Zou et al. Crit Care. .

Erratum in

Abstract

Background: Acute kidney injury (AKI) is a common clinical complication of cardiac surgery and increases mortality and hospitalization. We aimed to explore and perform an updated meta-analysis of qualitative and quantitative evaluations of the relationship between early renal replacement therapy (RRT) and mortality.

Methods: We searched the Chinese Biomedical Database, the Cochrane Library, EMBASE, Global Health, MEDLINE and PubMed.

Results: Fifteen studies (five randomized controlled trials (RCTs), one prospective cohort and nine retrospective cohorts) including 1479 patients were identified for detailed evaluation. The meta-analysis suggested that early RRT initiation reduced 28-day mortality (odds ratio (OR) 0.36; 95% confidence interval (CI) 0.23 to 0.57; I 2 60%), and shortened intensive care unit (ICU) length of stay (LOS) (mean difference (MD) -2.50; 95% CI -3.53 to -1.47; I 2 88%) and hospital LOS (MD -0.69; 95% CI -1.13 to -0.25; I 2 88%), and also reduced the duration of RRT (MD -1.18; 95% CI -2.26 to -0.11; I 2 69%), especially when RRT was initiated early within 12 hours (OR 0.23; 95% CI 0.08 to 0.63; I 2 73%) and within 24 hours (OR 0.52; 95% CI 0.28 to 0.95; I 2 58%) in patients with AKI after cardiac surgery.

Conclusions: Early RRT initiation decreased 28-day mortality, especially when it was started within 24 hours after cardiac surgery in patients with AKI.

Keywords: Acute kidney injury; Cardiac surgery; Early; Mortality; Renal replacement therapy.

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Figures

Fig. 1
Fig. 1
Study selection process. RCT randomized controlled trial, RRT renal replacement therapy, AKI acute kidney injury
Fig. 2
Fig. 2
Risk of bias and summary of risk of bias
Fig. 3
Fig. 3
Forest plots of all 15 studies showed evidence of survival advantage of early renal replacement therapy initiation compared to late in analysis of mortality in patients with acute kidney injury after cardiac surgery
Fig. 4
Fig. 4
Sensitivity analysis shows the meta-analysis has low sensitivity and satisfactory stability for analysis of patients with acute kidney injury after cardiac surgery
Fig. 5
Fig. 5
Publication bias according to Egger and Begg test funnel plots
See this image and copyright information in PMC

Comment in

References

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