Cochrane · systematic review · CD010612
Timing of kidney replacement therapy initiation for acute kidney injury
Fayad, AI, Buamscha, DG, Ciapponi, A · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
14
current version
GRADE rated
14
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 0 · 0%Low 4 · 28.6%Moderate 6 · 42.9%High 4 · 28.6%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyEarly versus standard initiation of kidney replacement therapy (KRT) in patients with acute kidney injury (AKI)
Population: AKI
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death at day 30Â Early vs standard initiation of kidney replacement therapy (KRT) | RR 0.97 [0.87, 1.09] | 12 studies · 4826 participants | Low Downgraded: imprecision |
Death after 30 days Early vs standard initiation of kidney replacement therapy (KRT) | RR 0.99 [0.92, 1.07] | 7 studies · 4534 participants | Moderate Downgraded: imprecision |
Death or non‐recovery of kidney function Time frame: day 90 Early vs standard initiation of kidney replacement therapy (KRT) | RR 0.91 [0.74, 1.11] | 6 studies · 4011 participants | Low Downgraded: imprecision |
Recovery of kidney function Patients free from KRT according to ITT analysis (all patients) Early vs standard initiation of kidney replacement therapy (KRT) | RR 1.07 [0.94, 1.22] | 10 studies · 4717 participants | Low Downgraded: imprecision |
Adverse events: hypophosphataemia Early vs standard initiation of kidney replacement therapy (KRT) | RR 1.8 [1.33, 2.44] | 1 study · 2927 participants | High |
Adverse events: hypotension Early vs standard initiation of kidney replacement therapy (KRT) | RR 1.54 [1.29, 1.85] | 5 studies · 3864 participants | High |
Adverse events: cardiac‐rhythm disorder Early vs standard initiation of kidney replacement therapy (KRT) | RR 1.35 [1.04, 1.75] | 6 studies · 4483 participants | High |
Adverse events: infection Early vs standard initiation of kidney replacement therapy (KRT) | RR 1.33 [1, 1.77] | 5 studies · 4252 participants | High |
Length of stay in ICU Early vs standard initiation of kidney replacement therapy (KRT) | no estimate extracted | 5 studies · 4240 participants | Moderate Downgraded: imprecision, inconsistency, indirectness |
Length of stay in hospital Early vs standard initiation of kidney replacement therapy (KRT) | no estimate extracted | 7 studies · 4589 participants | Moderate Downgraded: imprecision, inconsistency, indirectness |
Subgroup analyses: early versus standard initiation of kidney replacement therapy (KRT) in patients with acute kidney injury (AKI)
Population: AKI
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death by AKI aetiology: non‐surgical causes Subgroup analyses: early vs standard initiation of kidney replacement therapy (KRT) | RR 1.01 [0.94, 1.09] | 9 studies · 4461 participants | Moderate Downgraded: imprecision, inconsistency |
Death by AKI aetiology: surgical causes Subgroup analyses: early vs standard initiation of kidney replacement therapy (KRT) | RR 0.65 [0.31, 1.36] | 3 studies · 365 participants | Low Downgraded: imprecision |
Kidney recovery functionby KRT: continuous KRT Subgroup analyses: early vs standard initiation of kidney replacement therapy (KRT) | RR 1.42 [0.99, 2.03] | 6 studies · 583 participants | Moderate Downgraded: imprecision, inconsistency |
Kidney recovery functionby KRT: continuous and intermittent KRT Subgroup analyses: early vs standard initiation of kidney replacement therapy (KRT) | RR 0.96 [0.91, 1.02] | 4 studies · 4134 participants | Moderate Downgraded: imprecision |
Early versus standard renal replacement therapy (RRT) initiation for acute kidney injury (AKI)
Population: patients with AKI
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death at day 30 Early vs standard renal replacement therapy (RRT) initiation | RR 0.83 [0.61, 1.13] | 5 studies · 1084 participants | Low Downgraded: inconsistency |
Death after 30 days Early vs standard renal replacement therapy (RRT) initiation | RR 0.92 [0.76, 1.1] | 4 studies · 1056 participants | Moderate Downgraded: imprecision, inconsistency |
Death or non recovery kidney function at day 90 Early vs standard renal replacement therapy (RRT) initiation | RR 0.83 [0.66, 1.05] | 5 studies · 1078 participants | Low Downgraded: inconsistency |
Patients free of RRT after discontinuing RRT (all patients) Early vs standard renal replacement therapy (RRT) initiation | RR 1.13 [0.91, 1.4] | 5 studies · 1084 participants | Low Downgraded: inconsistency |
Number of patients with any adverse events Early vs standard renal replacement therapy (RRT) initiation | RR 1.1 [1.04, 1.17] | 3 studies · 437 participants | High |
ICU length of stay Early vs standard renal replacement therapy (RRT) initiation | no estimate extracted | 4 studies · 1056 participants | Low Downgraded: inconsistency |
Early initiation versus standard renal replacement therapy (RRT) for acute kidney injury (AKI): subgroup analysis
Population: patients with AKI who need RRT
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death: early initiation according to clinical‐biochemical criteria Early initiation vs standard renal replacement therapy (RRT) | RR 0.17 [0.05, 0.61] | 1 study · 28 participants | Low Downgraded: risk of bias |
Death: early initiation according to time criteria Early initiation vs standard renal replacement therapy (RRT) | RR 0.91 [0.78, 1.06] | 4 studies · 1049 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |