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Subject Area

General Surgery

Article Type

Review

Abstract

Objectives The aim of the present review is to synthesize evidence from the published literature about the effect of early versus late initiation of renal replacement therapy (RRT) on the outcomes of patients with acute kidney injury (AKI). Backgrounds AKI is a serious clinical disorder with significant increase in risk of mortality and morbidity, especially among hospitalized patients. Data sources A computer literature search of Medline via PubMed, Cochrane CENTRAL Register of Controlled Trials, SCOPUS, and Web of science was conducted. Study selection Records were screened for eligible studies according to the predetermined inclusion and exclusion criteria. Data extraction Data were extracted and synthesized using standardized tables. Data synthesis Dichotomous data were pooled as relative risk (RR) in a random-effect model using Mantel–Haenszel method. Continuous data were pooled as standardized mean difference (SMD) in generic-variance model. We used Review Manager 5.3 for Windows. Findings The present review included nine studies. Our pooled effect estimates did not favor early initiation of RRT versus late intuition in terms of all-causes mortality (RR = 0.88; 95% confidence interval (CI), 0.68, 1.14; P = 0.33), RRT dependence (RR = 0.81; 95% CI, 0.46, 1.42; P = 0.46), length of stay in ICU (SMD, −0.28; 95% CI, −0.58, 0.03; P = 0.08), and length of stay in hospital (SMD, −0.40; 95% CI, −0.83, 0.03; P = 0.07). Conclusion The present systematic review and meta-analysis shows that early initiation of RRT does not improve survival outcomes and hospital stay among patients with AKI, in comparison with late initiation of RRT.

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