Timing of continuous renal replacement therapy in acute kidney injury: a meta-analysis of randomized trials
A meta-analysis of 12 randomized trials found that starting continuous renal replacement therapy early in acute kidney injury did not reduce mortality and increased the risk of hypotension and electrolyte complications, though it shortened ICU stay and reduced dialysis dependence at discharge.
Background
Acute kidney injury (AKI) carries high mortality, and prior trials on the optimal timing of continuous renal replacement therapy (CRRT) have given inconsistent results, leaving uncertainty about whether earlier initiation helps.
Study design
Investigators searched PubMed, Embase, and Cochrane databases through June 2024 for randomized trials comparing early versus delayed CRRT initiation in AKI, pooling 28-, 60-, and 90-day mortality and adverse-event outcomes. Twelve RCTs with 1,244 patients were included.
Key findings
Early CRRT did not significantly affect 28-day mortality (RR 0.91; 95% CI 0.79–1.06). It was associated with shorter ICU stay (mean difference −3.24 days) and lower dialysis dependence at discharge (RR 0.57; 95% CI 0.32–0.99), but higher rates of hypotension (RR 1.26), thrombocytopenia (RR 1.53), and hypophosphatemia (RR 3.35).
Safety
The increased incidence of hypotension, thrombocytopenia, and hypophosphatemia with early initiation means CRRT timing should be individualized with explicit attention to these treatment-related harms rather than defaulting to early start.
Category
Research
Source
PLOS One
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