scholarly journals The impact of “early” versus “late” initiation of renal replacement therapy in critical care patients with acute kidney injury: a systematic review and evidence synthesis

Critical Care ◽  
2016 ◽  
Vol 20 (1) ◽  
Author(s):  
Benjamin T. Wierstra ◽  
Sameer Kadri ◽  
Soha Alomar ◽  
Ximena Burbano ◽  
Glen W. Barrisford ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Critical Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Evidence Synthesis ◽  
Kidney Injury ◽  
Late Initiation ◽  
The Impact ◽  
Critical Care Patients

scholarly journals Early versus late initiation of renal replacement therapy impacts mortality in septic patients with acute kidney injury: a meta-analysis

2020 ◽  
Author(s):  
Chenglong Ge ◽  
Yuan Jiang ◽  
Qianyi Peng ◽  
Yuhang Ai
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Cochrane Library ◽  
Optimal Time ◽  
Late Initiation ◽  
Beneficial Impact ◽  
The Impact

Abstract Background: Acute kidney injury (AKI) is a frequent complication in septic patients and increases in-hospital mortality. Our aim was to evaluate the impact of early versus late initiation of renal replacement therapy (RRT) on clinical outcomes in septic patients with acute kidney injury (AKI). Methods: Systematic review and meta-analysis were used in this study. We searched PubMed, EMBASE, MEDLINE and Cochrane Library. Results: Nine studies (two randomized controlled trials (RCTs) and seven retrospective cohorts) including 1694 patients were identified for detailed evaluation. This meta-analysis suggested that early RRT initiation within 48 hours (OR 0.30; 95% CI 0.20 to 0.45; I 2 0%) in septic patients with AKI reduced 28-day mortality (odds ratio (OR) 0.56; 95% confidence interval (CI) 0.37 to 0.86; I 2 73%), but intensive care unit (ICU) length of stay (LOS) (mean difference (MD) -1.49; 95% CI -3.65 to -0.67; I 2 53%), hospital LOS (MD -3.18; 95% CI -7.35 to 0.99; I 2 41%), the duration of RRT (MD -2.05; 95%CI -6.86 to 2.76; I 2 83%) and the duration of ventilation (MD 1.99; 95%CI -2.76 to 6.75; I 2 85%) were not influenced by the timing of RRT initiation. Conclusions: Early initiation of RRT within 48 hours in septic patients with AKI may have a beneficial impact on survival. However, this conclusion is based on heterogeneous trials of different quality and only two RCTs. Conclusive therapeutic recommendations regarding the optimal time to initiate RRT remain uncertain.

scholarly journals Renal replacement therapy in critical care in patients with acute kidney injury

2018 ◽  
Vol 51 (2) ◽  
pp. 141-148
Author(s):  
Shigeo Negi ◽  
Daisuke Koreeda ◽  
Masaki Higashiura ◽  
Takuro Yano ◽  
Sou Kobayashi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critical Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury

Indications for Dialysis in Acute Kidney Injury

2020 ◽  
Author(s):  
Ankit Patel ◽  
Kenneth B Christopher
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
High Efficiency ◽  
Kidney Injury ◽  
Intermittent Hemodialysis ◽  
Continuous Venovenous Hemofiltration ◽  
Continuous Venovenous Hemodialysis ◽  
Low Efficiency ◽  
The Impact

Renal replacement therapy (RRT) can be used to support patient’s kidney function in cases of acute kidney injury (AKI). However, timing, modality, and dosing of RRT continue to remain in question. Recent studies have begun to provide data to help guide clinicians on when to initiate RRT, what form of RRT to use ranging from continuous venovenous hemofiltration (VVH) to intermittent hemodialysis, and the impact of high versus low-intensity dosing. Additionally, the risks associated with temporary vascular access with regard to thrombosis and infection, the impact of high efficiency and flux versus low efficiency and flux membranes, and options for anticoagulation in RRT for AKI are also discussed. This review contains 75 references.  Key words: acute kidney injury, chronic kidney disease, continuous venovenous hemofiltration, continuous venovenous hemodialysis, renal replacement therapy, venovenous hemofiltration, 

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