Evidence map›Paper›PMID 27149861›Full record

SynthesisCritical care (London, England)2016

The impact of "early" versus "late" initiation of renal replacement therapy in critical care patients with acute kidney injury: a systematic review and evidence synthesis.

Benjamin T Wierstra, Sameer Kadri, Soha Alomar, Ximena Burbano, Glen W Barrisford, Raymond L C Kao

Open access · goldAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Critical care (London, England), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
47citing papers in PubMed, 13 pooled it
15.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

47 citing papers in PubMed, 13 syntheses or guidelines pooled it, 109 citations in OpenAlex.

  1. Timing of kidney replacement therapy initiation for acute kidney injury.The Cochrane database of systematic reviews · 2022
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  6. Timing of renal replacement therapy initiation for acute kidney injury.The Cochrane database of systematic reviews · 2018
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 2 countries.

Benjamin T WierstraDivision of Internal Medicine, Department of Medicine, University of Calgary, Calgary, AB, Canada.
Sameer KadriHarvard School of Public Health, Harvard University, Boston, MA, USA.
Soha AlomarHarvard School of Public Health, Harvard University, Boston, MA, USA.
Ximena BurbanoHarvard School of Public Health, Harvard University, Boston, MA, USA.
Glen W BarrisfordHarvard School of Public Health, Harvard University, Boston, MA, USA.
Raymond L C KaoHarvard School of Public Health, Harvard University, Boston, MA, USA. rkao3@uwo.ca.
Harvard University · USUniversity of Calgary · CAWestern University · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe optimal timing of initiating renal replacement therapy (RRT) in critical illness complicated by acute kidney injury (AKI) is not clearly established. Trials completed on this topic have been marked by contradictory findings as well as quality and heterogeneity issues. Our goal was to perform a synthesis of the evidence regarding the impact of "early" versus "late" RRT in critically ill patients with AKI, focusing on the highest-quality research on this topic.

methodsA literature search using the PubMed and Embase databases was completed to identify studies involving critically ill adult patients with AKI who received hemodialysis according to "early" versus "late"/"standard" criteria. The highest-quality studies were selected for meta-analysis. The primary outcome of interest was mortality at 1 month (composite of 28- and 30-day mortality). Secondary outcomes evaluated included intensive care unit (ICU) and hospital length of stay (LOS).

resultsThirty-six studies (seven randomized controlled trials, ten prospective cohorts, and nineteen retrospective cohorts) were identified for detailed evaluation. Nine studies involving 1042 patients were considered to be of high quality and were included for quantitative analysis. No survival advantage was found with "early" RRT among high-quality studies with an OR of 0.665 (95 % CI 0.384-1.153, p = 0.146). Subgroup analysis by reason for ICU admission (surgical/medical) or definition of "early" (time/biochemical) showed no evidence of survival advantage. No significant differences were observed in ICU or hospital LOS among high-quality studies.

conclusionsOur conclusion based on this evidence synthesis is that "early" initiation of RRT in critical illness complicated by AKI does not improve patient survival or confer reductions in ICU or hospital LOS.

Indexed as

Acute Kidney InjuryAdultCritical IllnessHumansIntensive Care UnitsLength of StayProspective StudiesRenal Replacement TherapyRetrospective StudiesAcute kidney injury (AKI)EarlyIntensive care units (ICUs)LateMeta-analysisRenal replacement therapy (RRT)

Identifiers

PMID27149861
PMCPMC4858821
OpenAlexW2346404696

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.