Abstract: FR-PO060
Timing of Initiation of Renal Replacement Therapy in Critically Ill Patients with AKI: A Systematic Review and Meta-Analysis
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
- Kalot, Mohamad A., University of kansas medical center, Kansas city, Missouri, United States
- Aljabiri, Yazan, Shmaisani Hospital, Amman, Jordan
- Chaudhry, Sultan, McMaster University, Hamilton, Ontario, Canada
- Husainat, Nedaa, Kansas University Medical Center, Kansas City, Missouri, United States
- Bhargava, Rhea, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Mustafa, Reem, Kansas University Medical Center, Kansas City, Missouri, United States
Background
Acute Kidney Injury is common in critically ill patients and has been associated with increased morbidity and mortality. The timing of initiation of renal replacement therapy(RRT) has been controversial in Acute Kidney Injury with no guidelines to help physicians make this decision. We aimed to analyze the prospective randomized clinical trials (RCTs) addressing this question and synthesize the evidence to guide clinical decision making for acutely ill patients who suffer from acute renal failure (ARF).
Methods
We performed a literature search using PubMed, Embase, clinicaltrials.gov, National Kidney Foundation and American Society of Nephrology meeting abstracts for 5 years. We identified RCTs involving critically ill patients and initiation strategies for renal replacement therapy. We then performed a meta-analysis, using Review Manager version 5.3. The outcome of interest included mortality, dialysis dependence, length of stay (LOS) in the hospital and in the intensive care unit (ICU).
Results
We identified 13 randomized control trials. The pooled estimates did not show a mortality difference between “early RRT” versus “Late RRT” with a RR of 1.01 (95% CI 0.99-1.10, p=0.88). We did not find a significant difference in the dialysis dependence at 90 days with a RR of 0.77 (95% CI 0.40-1.48, p=0.44). There was a decreased ICU LOS with a mean difference of 1.52 days (95% CI 0.6-2.44, p = 0.001) and hospital LOS with a mean difference of 6.26 days (95% CI 4.97-7.56, p<0.001) in the early RRT versus late RRT. Early RRT was associated with decreased hyperkalemia with RR of 0.57 (95% Cl 0.34-0.97, p=0.04) and respiratory complications with RR of 0.86 (95% CI 0.77 – 0.97, p=0.01).
Conclusion
Early initiation of RRT in ARF in critically ill patients does not seem to alter mortality or the dependence on long term dialysis. However, it does shorten the ICU and hospital LOS, and is associated with decreased hyperkalemia and respiratory complications.