Effects of early dialysis on the outcomes of critically ill patients with acute kidney injury: a systematic review and meta-analysis of randomized controlled trials

Lin, Wei−Ting; Lai, Chih‐Cheng; Chang, Sung‐Eun; Wang, Jian-Jhong

doi:10.1038/s41598-019-54777-9

Cited by 12 publications

(7 citation statements)

References 32 publications

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“…The incidence of AKI requiring dialysis in patients with severe sepsis has increased in recent years, and this may be attributed to the survival advantage associated with early dialysis initiation in patients with severe AKI, which has been recognized in previous studies [19]. In patients with sepsis-induced AKI, individual differences are variable; therefore, the novelty of our study is the use of a crossover design to minimize within-person confounding biases.…”

Section: Discussionmentioning

confidence: 94%

Risk of Kidney Injury Requiring Dialysis After Sepsis

Wong

Chen

et al. 2022

Preprint

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Background:Sepsis-associated acute kidney injury (AKI) can accelerate the progression of chronic kidney disease and lead to permanent kidney damage. However, the relationship between sepsis-associated AKI and dialysis has not been well evaluated. Our study aimed to investigate the risk of AKI requiring dialysis after sepsis.Methods:A nationwide population-based case-crossover study comprised all patients requiring their first dialysis from 2004 to 2016 from the database of Taiwan’s National Health Insurance. Patients aged <20 years or with missing data were excluded.Results:147,201 and 75,031 patients requiring acute temporary and chronic dialysis were included in this study. The odds ratios (ORs) for patients requiring acute temporary dialysis after sepsis were 15.77, 10.67, 9.23, and 8.36 for exposure periods of 1, 2, 3, and 4 weeks, respectively. For patients requiring chronic dialysis after sepsis, ORs were 6.99, 4.12, 4.16, and 3.66 for exposure periods of 1, 2, 3, and 4 weeks, respectively. In analyses using no overlapping time intervals, the risk remained the highest during the time closest to the event.Conclusions: This study demonstrated that patients with sepsis had a markedly increased risk of renal failure requiring dialysis and the risk was highest within 1 week of sepsis.

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Section: Discussionmentioning

confidence: 94%

Risk of Kidney Injury Requiring Dialysis After Sepsis

Wong

Chen

et al. 2022

Preprint

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“…This RCT was not included in the study by Gaudry et al [19] Our meta-analysis included 5279 patients who underwent randomization and could thus provide more robust and updated information than previous meta-analyses. [19][20][21][22][23] In summary, no difference in terms of mortality was observed between patients assigned to the accelerated-and standard-RRT strategies.…”

Section: Discussionmentioning

confidence: 99%

Accelerated-strategy renal replacement therapy for critically ill patients: A systematic review and meta-analysis

Lan

Lai

Chang³

et al. 2022

Medicine

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Background: The aim of this study was to investigate the clinical effect and safety of accelerated-strategy initiation of renal replacement therapy (RRT) in critically ill patients. Methods: PubMed, Embase, OVID, EBSCO, and the Cochrane Library databases were searched for relevant articles from inception to December 30, 2020. Only RCTs that compared the clinical efficacy and safety between accelerated-strategy RRT and standard-strategy RRT among critically ill adult patients with acute kidney injury (AKI) were included. The primary outcome was 28-day mortality. Results: A total of 5279 patients in 12 RCTs were included in this meta-analysis. The 28-day mortality rates of patients treated with accelerated and standard RRT were 37.3% (969/2596) and 37.9% (976/2573), respectively. No significant difference was observed between the groups (OR, 0.92; 95% CI, 0.70–1.12; I2 = 60%). The recovery rates of renal function were 54.5% and 52.5% in the accelerated- and standard-RRT groups, respectively, with no significant difference (OR, 1.03; 95% CI, 0.89–1.19; I2 = 56%). The rate of RRT dependency was similar in the accelerated- and standard-RRT strategies (6.7% vs 5.0%; OR, 1.11; 95% CI, 0.71–1.72; I2 = 20%). The accelerated-RRT group displayed higher risks of hypotension, catheter-related infection, and hypophosphatemia than the standard-RRT group (hypotension: OR, 1.26; 95% CI, 1.10–1.45; I2 = 36%; catheter-related infection: OR, 1.90; 95% CI, 1.17–3.09; I2 = 0%; hypophosphatemia: OR, 2.11; 95% CI, 1.43–3.15; I2 = 67%). Conclusions: Accelerated RRT does not reduce the risk of death and does not improve the recovery of kidney function among critically ill patients with AKI. In contrast, an increased risk of adverse events was observed in patients receiving accelerated RRT. However, these findings were based on low quality of evidence. Further large-scale RCTs is warranted.

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“…241 Additionally, a meta-analysis of 11 randomized controlled trials evaluating early and late RRT in critical illness found no difference in mortality but showed a higher incidence of catheter-associated infections and hypophosphatemia in the early RRT group. 242 Another meta-analysis of early versus late RRT in critical illness after cardiac surgery suggested benefit with early RRT; however, the studies had a high level of heterogeneity ( I 2 = 56%), and the authors specifically cite the absence of septic shock pathophysiology as a potential explanation for the benefit in these patients. 243 Taken together, these data do not support early RRT in patients with sepsis.…”

Section: Methodsmentioning

confidence: 99%

Sepsis With Preexisting Heart Failure: Management of Confounding Clinical Features

Jones

Smith

Tuyl

et al. 2020

J Intensive Care Med

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Preexisting heart failure (HF) in patients with sepsis is associated with worse clinical outcomes. Core sepsis management includes aggressive volume resuscitation followed by vasopressors (and potentially inotropes) if fluid is inadequate to restore perfusion; however, large fluid boluses and vasoactive agents are concerning amid the cardiac dysfunction of HF. This review summarizes evidence regarding the influence of HF on sepsis clinical outcomes, pathophysiologic concerns, resuscitation targets, hemodynamic interventions, and adjunct management (ie, antiarrhythmics, positive pressure ventilatory support, and renal replacement therapy) in patients with sepsis and preexisting HF. Patients with sepsis and preexisting HF receive less fluid during resuscitation; however, evidence suggests traditional fluid resuscitation targets do not increase the risk of adverse events in HF patients with sepsis and likely improve outcomes. Norepinephrine remains the most well-supported vasopressor for patients with sepsis with preexisting HF, while dopamine may induce more cardiac adverse events. Dobutamine should be used cautiously given its generally detrimental effects but may have an application when combined with norepinephrine in patients with low cardiac output. Management of chronic HF medications warrants careful consideration for continuation or discontinuation upon development of sepsis, and β-blockers may be appropriate to continue in the absence of acute hemodynamic decompensation. Optimal management of atrial fibrillation may include β-blockers after acute hemodynamic stabilization as they have also shown independent benefits in sepsis. Positive pressure ventilatory support and renal replacement must be carefully monitored for effects on cardiac function when HF is present.

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Effects of early dialysis on the outcomes of critically ill patients with acute kidney injury: a systematic review and meta-analysis of randomized controlled trials

Cited by 12 publications

References 32 publications

Risk of Kidney Injury Requiring Dialysis After Sepsis

Risk of Kidney Injury Requiring Dialysis After Sepsis

Accelerated-strategy renal replacement therapy for critically ill patients: A systematic review and meta-analysis

Sepsis With Preexisting Heart Failure: Management of Confounding Clinical Features

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