Comparison between watchful waiting strategy and early initiation of renal replacement therapy in the critically ill acute kidney injury population: an updated systematic review and meta-analysis

Annals of Intensive Care
Jia-Jin ChenChih-Hsiang Chang

Abstract

The optimal timing of renal replacement therapy (RRT) initiation is debatable. Many articles in this field enrolled trials not based on acute kidney injury. The safety of the watchful waiting strategy has not been fully discussed, and late RRT initiation criteria vary across studies. The effect of early RRT initiation in the AKI population with high plasma neutrophil gelatinase-associated lipocalin (NGAL) has not been examined yet. In accordance with PRISMA guidelines, the PubMed, Embase, and Cochrane databases were systemically searched for randomized controlled trials (RCTs). Trials not conducted in the AKI population were excluded. Data of study characteristics, primary outcome (all-cause mortality), and related secondary outcomes [mechanical ventilation (MV) days, length of hospital stay, RRT days, and length of ICU stay] were extracted. The outcomes were compared between early and late RRT groups by estimating the pooled odds ratio (OR) for binary outcomes and the weighted mean difference for continuous outcomes. Prospective trials were also examined and analyzed using the same method. Nine RCTs with 1938 patients were included. Early RRT did not provide a survival benefit (pooled OR, 0.88; 95% confidence interval [CI] 0.6...Continue Reading

References

Jul 1, 1990·Critical Care Medicine·J A LowellB R Bistrian
Aug 18, 2004·Critical Care : the Official Journal of the Critical Care Forum·Rinaldo BellomoUNKNOWN Acute Dialysis Quality Initiative workgroup
Mar 3, 2007·Critical Care : the Official Journal of the Critical Care Forum·Ravindra L MehtaUNKNOWN Acute Kidney Injury Network
Aug 19, 2007·Clinical Journal of the American Society of Nephrology : CJASN·Kathleen D LiuGlenn M Chertow
Aug 19, 2007·Clinical Journal of the American Society of Nephrology : CJASN·Sean M BagshawUNKNOWN Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators
Dec 18, 2007·Journal of Clinical Epidemiology·Jørn WetterslevChristian Gluud
Jun 6, 2008·Critical Care : the Official Journal of the Critical Care Forum·Didier PayenUNKNOWN Sepsis Occurrence in Acutely Ill Patients (SOAP) Investigators
Jun 20, 2008·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Victor F SeabraBertrand L Jaber
Oct 1, 2008·International Journal of Epidemiology·Kristian ThorlundChristian Gluud
Feb 13, 2009·Hemodialysis International·Hikmet IyemSuat Büket
Feb 25, 2009·Critical Care Medicine·Didier PayenUNKNOWN Hemofiltration and Sepsis Group of the Collège National de Réanimation et de Médecine d'Urgence des Hôpitaux extra-Universit
Mar 11, 2009·Journal of Critical Care·Sean M BagshawUNKNOWN Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators
May 14, 2009·Kidney International·Josée BouchardUNKNOWN Program to Improve Care in Acute Renal Disease (PICARD) Study Group
Jul 25, 2009·Journal of the American Society of Nephrology : JASN·Edward D SiewT Alp Ikizler
Nov 3, 2009·Critical Care : the Official Journal of the Critical Care Forum·Chih-Chung ShiaoUNKNOWN National Taiwan University Surgical Intensive Care Unit-Associated Renal Failure Study Group
Dec 23, 2009·Nature Reviews. Nephrology·John R ProwleRinaldo Bellomo
May 13, 2010·American Journal of Respiratory and Critical Care Medicine·Laurent BrochardUNKNOWN ATS/ERS/ESICM/SCCM/SRLF Ad Hoc Committee on Acute Renal Failure
Dec 3, 2010·Critical Care : the Official Journal of the Critical Care Forum·Monique M ElseviersUNKNOWN SHARF investigators
Mar 1, 2011·Critical Care : the Official Journal of the Critical Care Forum·Constantine J KarvellasSean M Bagshaw
May 19, 2011·Critical Care : the Official Journal of the Critical Care Forum·Christophe Clec'hJean-François Timsit
Oct 20, 2011·BMJ : British Medical Journal·Julian P T HigginsUNKNOWN Cochrane Statistical Methods Group
Jun 8, 2013·Clinical Journal of the American Society of Nephrology : CJASN·Paweena SusantitaphongUNKNOWN Acute Kidney Injury Advisory Group of the American Society of Nephrology
Aug 13, 2013·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Tukaram E JamaleDinesh Mahajan
Apr 11, 2014·Critical Care Medicine·Min JunUNKNOWN Randomized Evaluation of Normal Versus Augmented Level of Replacement Therapy (RENAL) Study Investigators
Aug 12, 2014·Clinical Journal of the American Society of Nephrology : CJASN·Suvi T VaaraUNKNOWN FINNAKI Study Group
Feb 7, 2015·Journal of the American Society of Nephrology : JASN·Jay L KoynerLakhmir S Chawla
Jul 15, 2015·Kidney International·Ron WaldUNKNOWN Canadian Critical Care Trials Group
Jul 15, 2015·Intensive Care Medicine·Eric A J HosteJohn A Kellum
Jul 15, 2015·American Journal of Respiratory and Critical Care Medicine·Alain CombesCharles-Edouard Luyt
Feb 18, 2016·Critical Care : the Official Journal of the Critical Care Forum·An ZhangYue-Hui Yin
May 18, 2016·The New England Journal of Medicine·Stéphane GaudryUNKNOWN AKIKI Study Group
Aug 27, 2016·Blood Purification·Marlies OstermannUNKNOWN 17th Acute Disease Quality Initiative (ADQI) Consensus Group

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Citations

May 10, 2020·Critical Care : the Official Journal of the Critical Care Forum·Jia-Jin ChenGeorge Kuo
Mar 13, 2021·Journal of the Formosan Medical Association = Taiwan Yi Zhi·Jia-Jin ChenChih-Hsiang Chang
Mar 24, 2021·Critical Care Clinics·Sean M Bagshaw, Ron Wald
Apr 21, 2021·Expert Review of Molecular Diagnostics·Jia-Jin ChenChih-Hsiang Chang

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Clinical Trials Mentioned

NCT02568722
NCT03396757

Software Mentioned

TSA
Cochrane Collaboration
GRADEpro
Trial Sequential Analysis ( TSA )
Review Manager ( RevMan )
Comprehensive Meta - Analysis

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