Timing of kidney replacement therapy initiation for acute kidney injury

Fayad, Alicia; Buamscha, Daniel; Ciapponi, Agustín

doi:10.1002/14651858.cd010612.pub3

Cited by 8 publications

(5 citation statements)

References 200 publications

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“…Similar conclusions have been reached in subsequent RCT studies (IDEAL-ICU and STARRT-AKI) [69, 70]. A number of subsequent meta-analyses have also indicated that early treatment strategies do not provide patients with survival benefits if urgent indications are not present for CRRT but may result in unnecessary CRRT exposure for some patients, resulting in waste of medical resources and a higher risk of adverse side effects associated with CRRT [71‒74]. Consequently, it is not recommended that CRRT be initiated early [75].…”

Section: Discussionmentioning

confidence: 67%

Global Scientific Trends in Continuous Renal Replacement Therapy from 2000 to 2023: A Bibliometric and Visual Analysis

Tao,

Feng,

Wang

et al. 2024

Blood Purif

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Introduction: Continuous renal replacement therapy (CRRT) is one of the most widely used blood purification and organ support methods in the ICU. However, the development process, the current status, hotspots, and future trends of CRRT remain unclear. Method: The WoSCC database was used to analyze CRRT research evolution and theme trends. VOSviewer was used to construct co-authorship, co-occurrence, co-citation, and network visualizations. Citespace is used to detect bursts for co-occurrence items. Several important subtopics were reviewed and discussed in more detail. Results: Global publications increased from 56 in 2000 to 398 in 2023, a 710.71% increase. Blood Purification published the most manuscripts, followed by International Journal of Artificial Organs. The United States, the San Bortolo Hospital, and Bellomo, R were the most productive and impactful institution, country, and author respectively. Based on co-occurrence cluster analysis, five clusters emerged: (1) Clinical applications and management of CRRT; (2) Sepsis and CRRT; (3) CRRT anticoagulant management; (4) CRRT and antibiotic pharmacokinetics and pharmacodynamics; and (5) Comparison of CRRT and intermittent hemodialysis. COVID-19, initiation, ECOMO, cefepime, guidelines, cardiogenic shock, biomarker and outcome were the latest high-frequency keywords or strongest bursts, indicating the emerging frontiers of CRRT. Conclusions: There has been widespread publication and citation of CRRT research in the past two decades. We provide an overview of current trends, global collaboration patterns, basic knowledge, research hotspots, and emerging frontiers.

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Section: Discussionmentioning

confidence: 67%

Global Scientific Trends in Continuous Renal Replacement Therapy from 2000 to 2023: A Bibliometric and Visual Analysis

Tao,

Feng,

Wang

et al. 2024

Blood Purif

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“…This is in line with the observed frequency in a recent systematic review on cardiac arrest survivors [ 2 ]. Despite the frequent use of CKRT, several large randomized trials have found no survival benefit from especially early and aggressive use of CKRT in critically ill patients [ 20 – 22 ]. Similarly, a recent study on cardiac arrest patients found no difference in in-hospital survival between patients with AKI requiring CKRT within 72 h of admission and patients without the need for CKRT [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury after out-of-hospital cardiac arrest

Jeppesen,

Rasmussen,

Kjaergaard

et al. 2024

Crit Care

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Background Acute kidney injury (AKI) is a significant risk factor associated with reduced survival following out-of-hospital cardiac arrest (OHCA). Whether the severity of AKI simply serves as a surrogate measure of worse peri-arrest conditions, or represents an additional risk to long-term survival remains unclear. Methods This is a sub-study derived from a randomized trial in which 789 comatose adult OHCA patients with presumed cardiac cause and sustained return of spontaneous circulation (ROSC) were enrolled. Patients without prior dialysis dependent kidney disease and surviving at least 48 h were included (N = 759). AKI was defined by the kidney disease: improving global outcome (KDIGO) classification, and patients were divided into groups based on the development of AKI and the need for continuous kidney replacement therapy (CKRT), thus establishing three groups of patients—No AKI, AKI no CKRT, and AKI CKRT. Primary outcome was overall survival within 365 days after OHCA according to AKI group. Adjusted Cox proportional hazard models were used to assess overall survival within 365 days according to the three groups. Results In the whole population, median age was 64 (54–73) years, 80% male, 90% of patients presented with shockable rhythm, and time to ROSC was median 18 (12–26) min. A total of 254 (33.5%) patients developed AKI according to the KDIGO definition, with 77 requiring CKRT and 177 without need for CKRT. AKI CKRT patients had longer time-to-ROSC and worse metabolic derangement at hospital admission. Overall survival within 365 days from OHCA decreased with the severity of kidney injury. Adjusted Cox regression analysis found that AKI, both with and without CKRT, was significantly associated with reduced overall survival up until 365 days, with comparable hazard ratios relative to no AKI (HR 1.75, 95% CI 1.13–2.70 vs. HR 1.76, 95% CI 1.30–2.39). Conclusions In comatose patients who had been resuscitated after OHCA, patients developing AKI, with or without initiation of CKRT, had a worse 1-year overall survival compared to non-AKI patients. This association remains statistically significant after adjusting for other peri-arrest risk factors. Trial registration: The BOX trial is registered at ClinicalTrials.gov: NCT03141099.

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“…A meta-analysis of 12 studies with 4880 participants of all ages found no significant difference between early or late-onset dialysis in terms of survival but in terms of cost [28].…”

Section: When To Start a Dialysis Session?mentioning

confidence: 97%

Dialytic Treatment of Acute Renal Failure in Children

Batouche,

Elhalimi

2024

Updates on Renal Replacement Therapy

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Renal replacement therapy (RRT) ensures the removal of water and solutes that are not or no longer sufficiently ensured by the kidneys: Acute renal failure (AKI) remains the oldest indication, regardless of the patient’s age. All the methods of extracorporeal purification (peritoneal dialysis, conventional hemodialysis, and continuous extracorporeal purification) have been developed in children to compensate for renal function when it becomes totally or partially inadequate, and primarily or secondarily the RRT must be initiated without delay in life-threatening situations (hyperkalemia, metabolic acidosis, lysis syndrome, pulmonary edema refractory to medical treatment…). There are insufficient data to define the optimal time for initiation of RRT outside of life-threatening situations. Despite the lack of specific studies, the benefit of ERA in life-threatening situations seems reasonable, which is why most experts recommend its use in these situations. The CRRT has proven its effectiveness in pediatrics. The continuous and progressive nature of CRRT, particularly hemofiltration, makes it the therapy of choice for unstable ICU patients. The choice of the RRT method in a given center is therefore based on the type of patient to be treated, but also on technical availability, experience, and local skills.

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Timing of kidney replacement therapy initiation for acute kidney injury

Cited by 8 publications

References 200 publications

Global Scientific Trends in Continuous Renal Replacement Therapy from 2000 to 2023: A Bibliometric and Visual Analysis

Global Scientific Trends in Continuous Renal Replacement Therapy from 2000 to 2023: A Bibliometric and Visual Analysis

Acute kidney injury after out-of-hospital cardiac arrest

Dialytic Treatment of Acute Renal Failure in Children

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