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Please note that you are viewing an archived section from 2019 and some content may be unavailable. To unlock all content for 2019, please visit the archives.

Abstract: FR-PO068

Comparison of Outcomes of Early vs. Delayed Renal Replacement Therapy in Critically Ill Patients: A Meta-Analysis of Randomized Controlled Trials

Session Information

  • AKI: Clinical Outcomes, Trials
    November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Rajabalan, Ajai S., Emory University School of Medicine, Atlanta, Georgia, United States
  • Vaidya, Satyanarayana R., Emory University School of Medicine, Atlanta, Georgia, United States
  • Karki, Niraj, Emory University School of Medicine, Atlanta, Georgia, United States
  • Suarez, Jonathan J., Emory University School of Medicine, Atlanta, Georgia, United States
  • Cobb, Jason, Emory University School of Medicine, Atlanta, Georgia, United States
  • Bailey, James L., Emory University School of Medicine, Atlanta, Georgia, United States
Background

The question of optimal timing of Renal Replacement Therapy (RRT) initiation in Acute Kidney Injury (AKI) remains unanswered. We collected data from available randomized controlled trials (RCTs) comparing the early RRT (ERRT) with delayed RRT (DRRT) and performed a meta-analysis of outcomes.

Methods

A literature search was done using electronic databases from Pubmed, Cochrane and Embase from inception until April 2019 for RCTs comparing early RRT with delayed RRT. The relevant data was extracted and statistical analysis was done using RevMan 5.3.

Results

A total of 12 RCTs comparing ERRT vs DRRT in patients older than 18 years were included, yielding 2267 patients of which 1143 were in early RRT group and 1124 were in delayed RRT group. Mortality at 30 days (8 RCT) [OR 0. 95, 95%CI (0. 77, 1. 17), p=0. 60, I2 =12%] and 90 days (11 RCTs) [OR 0. 96, 95%CI (0. 80, 1. 14), p=0. 64, I2 =49%] did not show any difference between the 2 groups. There was no significant difference between the 2 groups in dependence on RRT at 90 days (5 RCTs) [OR 0. 80, 95%CI (0. 52, 1. 23), p=0. 31, I2 =0%] or incidence of arrythmias (5 RCTs) [OR 1. 01, 95%CI (0. 74, 1. 38), p=0. 94, I2 =29%]. Patients in DRRT group had significantly lower rates of catheter related complications (5 RCTs) [OR 1.80, 95%CI (1.08, 3. 01), p=0. 02, I2 =0%].

Conclusion

ERRT did not show any benefit in mortality, dependence on RRT or arrythmias. However, ERRT did show increased rates of catheter related complications. This suggests that DRRT may not offer benefits in mortality or renal outcomes, but may lead to less vascular access related complications. More data is needed to better elucidate the cause of less catheter related complications in the DRRT group.