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Early initiation of renal replacement therapy fails to improve survival rates in AKI patients
Early initiation of renal replacement therapy fails to improve survival rates in AKI patients suggests a news study published in the European Review for Medical and Pharmacological Sciences
The optimal time to start renal replacement therapy (RRT) for acute kidney injury (AKI) remains controversial. They aim to compare the effects of early vs. delayed RRT initiation on clinical outcomes in adult patients with AKI.
PubMed, Embase, Cochrane Library, Web of Science, Chinese Biomedical Literature Database, ClinicalTrials.gov, and the International Clinical Trial registry platform were systematically searched from inception to 7 August 2022. The review included randomized clinical trials (RCTs) comparing early and delayed initiation of RRT in AKI patients. The selected primary outcomes were short-term and long-term mortality. Secondary outcomes included RRT dependency, intensive care unit (ICU) length of stay, hospital length of stay, mechanical ventilator-free days, vasoactive agents-free days, RRT-free days, and adverse events.
RESULTS:
Overall, 15 RCTs, including 5,625 patients, were analyzed. Early RRT showed no survival benefit when compared to the delayed therapy (28-or 30-day mortality: RR, 1.01, 95% CI: 0.94-1.08, p = 0.87; 60-day mortality: RR, 0.87, 95% CI: 0.71-1.06, p = 0.16; 90-day mortality: RR, 1.00, 95% CI: 0.88-1.13, p = 0.97; in-hospital mortality: RR, 1.05, 95% CI: 0.88-1.24, p = 0.58; ICU mortality: RR, 1.00, 95% CI: 0.91-1.10, p = 0.98). The delayed RRT did not lead to a higher risk of RRT dependency, ICU, or hospital length of stay than the early RRT. Similarly, early initiation of RRT did not lead to longer ventilator-free, vasoactive agent-free, and RRT-free days. However, early RRT initiation was associated with more adverse events.
The study suggested that early RRT initiation was not associated with survival benefits or better clinical outcomes and increased the risk of RRT-associated adverse events. Current evidence does not support the use of early RRT for AKI patients without urgent indications.
Reference:
J.-H. Li, J.-H. Cai, M.-J. Wang, Z. Zeng, H.-Y. Du, J. Lu, Z. Li, X.-M. Zeng, Q. Tang. Early strategy vs. late initiation of renal replacement therapy in adult patients with acute kidney injury: an updated systematic review and meta-analysis of randomized controlled trials. Eur Rev Med Pharmacol Sci 2023; 27 (13): 6046-6057.DOI: 10.26355/eurrev_202307_32959
Keywords:
Early, initiation, renal, replacement, therapy, fails, improve, survival rates, AKI patients, J.-H. Li, J.-H. Cai, M.-J. Wang, Z. Zeng, H.-Y. Du, J. Lu, Z. Li, X.-M. Zeng, Q. Tang, European Review for Medical and Pharmacological Sciences
Dr. Shravani Dali has completed her BDS from Pravara institute of medical sciences, loni. Following which she extensively worked in the healthcare sector for 2+ years. She has been actively involved in writing blogs in field of health and wellness. Currently she is pursuing her Masters of public health-health administration from Tata institute of social sciences. She can be contacted at editorial@medicaldialogues.in.
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751