Effect of renal replacement therapy timing on prognosis of adult patients with acute kidney injury: a meta-analysis

doi:10.3877/cma.j.issn.1674-6880.2020.05.007

Abstract

Abstract:

Objective

To evaluate the effect of renal replacement therapy (RRT) timing on the prognosis of adult patients with acute kidney injury (AKI).

Methods

Systematic searches were conducted in the PubMed, Cochrane Library and Embase database to collect randomized controlled trials (RCTs) about the early and delayed initiation of RRT for adult patients with AKI published up to February 2019. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. Meta-analysis was conducted using the Revman 5.3 software.

Results

Eleven RCTs involving 2 332 AKI patients were enrolled. Meta-analysis demonstrated that the total mortality [risk ratio (RR) = 0.92, 95% confidence interval (CI) (0.78, 1.09), Z = 5.53, P = 0.35], 14 d mortality [RR = 0.84, 95%CI (0.66, 1.07), Z = 1.40, P = 0.16], 30 d mortality [RR = 0.98, 95%CI (0.83, 1.10) , Z = 0.40, P = 0.69], 60 d mortality [RR = 0.97, 95%CI (0.87, 1.07), Z = 0.67, P = 0.50], 90 d mortality [RR = 1.00, 95%CI (0.89, 1.12), Z = 0.01, P = 0.99], ICU stay[standardized mean difference (SMD) = -0.08, 95%CI (-0.18, 0.02), Z = 1.63, P = 0.10] and hospital stay [SMD = -0.16, 95%CI (-0.32, 0.00), Z = 1.96, P = 0.05] were not significantly different between AKI patients with the early and delayed initiation of RRT.

Conclusion

Early initiation of RRT cannot improve the prognosis of adult patients with AKI.

Key words: Acute kidney injury, Renal replacement therapy, Timing, Prognosis, Meta-analysis

Dongxue Xu, Fang Jiang, Xiaoyi Zhang, Ye Liu, Zhiyong Peng. Effect of renal replacement therapy timing on prognosis of adult patients with acute kidney injury: a meta-analysis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2020, 13(05): 356-363.

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Figures/Tables 10

References 27

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纳入文献	早期RRT	晚期RRT
Gaudry等^[8]	KDIGO诊断为AKI 3期后6 h内开始	至少符合以下标准之一：严重高钾血症、代谢性酸中毒、肺水肿、血尿素氮水平高于1 120 mg/L或随机化后少尿72 h以上
Bouman等^[10]	纳入后12 h内开始	常规的RRT标准
Durmaz等^[11]	冠状动脉旁路移植术前预防性血液透析	冠状动脉旁路移植术后血液透析
Sugahara等^[12]	当尿量降至30 mL/h以下时开始接受透析治疗的患者	冠状动脉旁路移植术后14 d，直到尿量小于20 mL/h才开始透析治疗
Liu等^[13]	血尿素氮<760 mg/L	血尿素氮>760 mg/L
Payen等^[14]	诊断为脓毒症后立即启动	常规的RRT标准
Wald等^[15]	患者在符合资格后12 h内开始	患者在符合资格后平均31.6 h开始
Comes等^[16]	心脏手术后24 h内有持续的术后休克	常规的RRT标准
Zarbock等^[17]	KDIGO诊断为AKI 2期后8 h内启动	KOIGO诊断为AKI 3期后12 h内启动
Barbar等^[18]	AKI发病后12 h内开始	AKI发病后48 h肾功能没有恢复
Jamale等^[19]	血清尿素氮和（或）肌酐水平分别升到700 mg/L和70 mg/L	常规的RRT标准

纳入文献	早期RRT	晚期RRT
Gaudry等^[8]	KDIGO诊断为AKI 3期后6 h内开始	至少符合以下标准之一：严重高钾血症、代谢性酸中毒、肺水肿、血尿素氮水平高于1 120 mg/L或随机化后少尿72 h以上
Bouman等^[10]	纳入后12 h内开始	常规的RRT标准
Durmaz等^[11]	冠状动脉旁路移植术前预防性血液透析	冠状动脉旁路移植术后血液透析
Sugahara等^[12]	当尿量降至30 mL/h以下时开始接受透析治疗的患者	冠状动脉旁路移植术后14 d，直到尿量小于20 mL/h才开始透析治疗
Liu等^[13]	血尿素氮<760 mg/L	血尿素氮>760 mg/L
Payen等^[14]	诊断为脓毒症后立即启动	常规的RRT标准
Wald等^[15]	患者在符合资格后12 h内开始	患者在符合资格后平均31.6 h开始
Comes等^[16]	心脏手术后24 h内有持续的术后休克	常规的RRT标准
Zarbock等^[17]	KDIGO诊断为AKI 2期后8 h内启动	KOIGO诊断为AKI 3期后12 h内启动
Barbar等^[18]	AKI发病后12 h内开始	AKI发病后48 h肾功能没有恢复
Jamale等^[19]	血清尿素氮和（或）肌酐水平分别升到700 mg/L和70 mg/L	常规的RRT标准

纳入文献	年龄（岁， ± s）	样本量（例）		SOFA评分（分， ± s）		APACHEⅡ评分（分， ± s）
纳入文献	年龄（岁， ± s）	早期RRT	晚期RRT	早期RRT	晚期RRT	早期RRT	晚期RRT
Gaudry等^[8]	66.1 ± 13.9	311	308	10.9 ± 3.2	10.8 ± 3.1	-	-
Bouman等^[10]	62.1 ± 16.6	35	36	10.1 ± 2.2	10.6 ± 1.9	21.7 ± 5.5	23.6 ± 8.3
Durmaz等^[11]	56.1 ± 11.5	21	23	-	-	-	-
Sugahara等^[12]	64.5 ± 2.5	14	14	-	-	18 ± 3	19 ± 2
Liu等^[13]	56.0 ± 2.2	122	121	-	-	-	-
Payen等^[14]	58.1 ± 13.0	37	39	54.3 ± 7.3	52.4 ± 7.5	11.6 ± 3.4	10.4 ± 2.9
Wald等^[15]	63.1 ± 12.8	48	52	12.0 ± 3.3	11.9 ± 2.0	-	-
Comes等^[16]	59.0 ± 15.1	112	112	11.5 ± 2.8	12.0 ± 2.9	-	-
Zarbock等^[17]	67.0 ± 13.1	112	119	15.6 ± 2.3	16.0 ± 2.3	30.6 ± 7.5	32.7 ± 8.8
Barbar等^[18]	69.0 ± 12.2	246	242	12.2 ± 2.9	12.4 ± 2.9	-	-
Jamale等^[19]	42.4 ± 15.3	102	106	7.6 ± 3.3	8.2 ± 3.1	-	-

纳入文献	年龄（岁， ± s）	样本量（例）		SOFA评分（分， ± s）		APACHEⅡ评分（分， ± s）
纳入文献	年龄（岁， ± s）	早期RRT	晚期RRT	早期RRT	晚期RRT	早期RRT	晚期RRT
Gaudry等^[8]	66.1 ± 13.9	311	308	10.9 ± 3.2	10.8 ± 3.1	-	-
Bouman等^[10]	62.1 ± 16.6	35	36	10.1 ± 2.2	10.6 ± 1.9	21.7 ± 5.5	23.6 ± 8.3
Durmaz等^[11]	56.1 ± 11.5	21	23	-	-	-	-
Sugahara等^[12]	64.5 ± 2.5	14	14	-	-	18 ± 3	19 ± 2
Liu等^[13]	56.0 ± 2.2	122	121	-	-	-	-
Payen等^[14]	58.1 ± 13.0	37	39	54.3 ± 7.3	52.4 ± 7.5	11.6 ± 3.4	10.4 ± 2.9
Wald等^[15]	63.1 ± 12.8	48	52	12.0 ± 3.3	11.9 ± 2.0	-	-
Comes等^[16]	59.0 ± 15.1	112	112	11.5 ± 2.8	12.0 ± 2.9	-	-
Zarbock等^[17]	67.0 ± 13.1	112	119	15.6 ± 2.3	16.0 ± 2.3	30.6 ± 7.5	32.7 ± 8.8
Barbar等^[18]	69.0 ± 12.2	246	242	12.2 ± 2.9	12.4 ± 2.9	-	-
Jamale等^[19]	42.4 ± 15.3	102	106	7.6 ± 3.3	8.2 ± 3.1	-	-

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