Timing of Renal Replacement Therapy Initiation in Acute Renal Failure: A Meta-analysis

Seabra, Victor F.; Balk, Ethan M; Liangos, Orfeas; Sosa, Marie Anne; Cendoroglo, Miguel; Jaber, Bertrand L.

doi:10.1053/j.ajkd.2008.02.371

Cited by 280 publications

(200 citation statements)

References 41 publications

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“…In children undergoing cardiac surgery, severe AKI is an independent predictor of postoperative death, as strong as the functional single ventricle and the requirement for postoperative circulatory support (2). The currently available data suggest a trend toward reduced mortality and better renal recovery with earlier initiation of RRT (3,4). The primary challenge in improving AKI outcomes over the past decade has been the late detection of AKI by the variation in serum creatinine (sCr), and substantial research has been focused on the discovery and validation of biomarkers to detect AKI before the rise in sCr (5).…”

Section: Introductionmentioning

confidence: 99%

Predictive Performance of Urine Neutrophil Gelatinase-Associated Lipocalin for Dialysis Requirement and Death Following Cardiac Surgery in Neonates and Infants

Bojan¹,

Vicca

Lopez-Lopez³

et al. 2014

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Urine neutrophil gelatinase-associated lipocalin (uNGAL) has been shown to accurately predict and allow early detection of AKI, as assessed by an increase in serum creatinine in children and adults. The present study explores the accuracy of uNGAL for the prediction of severe AKI-related outcomes in neonates and infants undergoing cardiac surgery: dialysis requirement and/or death within 30 days.Design, setting, participants, & measurements Prospective, observational cohort study conducted in a tertiary referral pediatric cardiac intensive care unit, including 75 neonates and 125 infants undergoing surgery with cardiopulmonary bypass between August 1, 2010, and May 31, 2011. Urine samples were collected before surgery and at median of five time points within 48 hours of bypass. Urine NGAL was quantified as absolute concentration, creatinine-normalized concentration, and absolute excretion rate, and a clusterization algorithm was applied to the individual uNGAL kinetics. The accuracy for the prediction of the outcome was assessed using receiver-operating characteristic areas, likelihood ratios, diagnostic odds ratios, net reclassification index, integrated reclassification improvement, and number needed to screen.Results A total of 1176 urine samples were collected. Of all patients, 8% required dialysis and 4% died. Three clusters of uNGAL kinetics were identified, including patients with significantly different outcomes. The uNGAL level peaked between 1 and 3 hours of bypass and remained high in half of all patients who required dialysis or died. The uNGAL levels measured within 24 hours of bypass accurately predicted the outcome and performed best after normalization to creatinine, with varying cutoffs according to the time elapsed since bypass. The number needed to screen to correctly identify the risk of dialysis or death in one patient varied between 1.5 and 2.6 within 12 hours of bypass.Conclusions uNGAL is a valuable predictive tool of dialysis requirement and death in neonates and infants with AKI after cardiac surgery.

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Section: Introductionmentioning

confidence: 99%

Predictive Performance of Urine Neutrophil Gelatinase-Associated Lipocalin for Dialysis Requirement and Death Following Cardiac Surgery in Neonates and Infants

Bojan¹,

Vicca

Lopez-Lopez³

et al. 2014

Clinical Journal of the American Society of Nephrology

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show abstract

“…In a cohort study in which data were analyzed according to the blood urea nitrogen (BUN) concentration at the start of dialysis, Liu et al [191] reported that initiation of dialysis at a BUN of [76 mg/dL was associated with an increased mortality. In a meta-analysis of studies including the study reported by Liu et al, early initiation of dialysis may lower mortality according to the results of cohort studies, although the criteria for initiating dialysis was not clearly described [192]. However, there was no significant difference in the recovery of kidney function by the timing of the initiation of dialysis.…”

Section: Level Of Evidence: I Grade Of Recommendation: B Rationale Cqmentioning

confidence: 99%

“…In summary, there is no evidence demonstrating the efficacy of RRT in patients with non-oliguric CIN. However, early RRT may decrease mortality and the incidence of major complications including kidney dysfunction in critically ill patients with oliguric CIN [192,194]. The vital prognosis is poor for CKD patients who developed CIN.…”

Section: Level Of Evidence: I Grade Of Recommendation: B Rationale Cqmentioning

confidence: 99%

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

et al. 2013

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“…In 1.2 to 3.0 % of those patients, renal replacement therapy (RRT) is required [4,5]. There is a wide variation throughout the world on the indications for, and for when RRT is started [6][7][8]. Moreover, the termination of continuous RRT (CRRT) is affected by strongly held physician beliefs and organizational aspects of a given institution.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Time to Terminate Continuous Renal Replacement Therapy in Patients with Acute Kidney Injury Following Cardiovascular Surgery in Association with or without a Mechanical Ventilation Support

Tsuchiya¹

2014

J Nephrol Ther

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Timing of Renal Replacement Therapy Initiation in Acute Renal Failure: A Meta-analysis

Cited by 280 publications

References 41 publications

Predictive Performance of Urine Neutrophil Gelatinase-Associated Lipocalin for Dialysis Requirement and Death Following Cardiac Surgery in Neonates and Infants

Predictive Performance of Urine Neutrophil Gelatinase-Associated Lipocalin for Dialysis Requirement and Death Following Cardiac Surgery in Neonates and Infants

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

Evaluation of the Time to Terminate Continuous Renal Replacement Therapy in Patients with Acute Kidney Injury Following Cardiovascular Surgery in Association with or without a Mechanical Ventilation Support

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