Evidence map›Paper›PMID 28382597›Full record

ArticleAnnals of intensive care2017

Earlier versus later initiation of renal replacement therapy among critically ill patients with acute kidney injury: a systematic review and meta-analysis of randomized controlled trials.

Tai-Shuan Lai, Chih-Chung Shiao, Jian-Jhong Wang, Chun-Te Huang, Pei-Chen Wu, Eric Chueh, Shih-Chieh Jeff Chueh, Kianoush Kashani, Vin-Cent Wu

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

Article in Annals of intensive care, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 9 pooled it
4.2field-weighted citation impact, top 5% 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

22 citing papers in PubMed, 9 syntheses or guidelines pooled it, 46 citations in OpenAlex.

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  8. Timing of renal replacement therapy initiation for acute kidney injury.The Cochrane database of systematic reviews · 2018
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  20. Timing of Renal Replacement Therapy in Acute Kidney Injury: Shedding New Light on an Old Controversy.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2018
    Review
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

9 authors at 8 institutions in 2 countries.

Tai-Shuan LaiDivision of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, No. 87, Neijiang St, Taipei, 108, Taiwan.
Chih-Chung ShiaoDivision of Nephrology, Department of Internal Medicine, Saint Marys Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan, 26546, Taiwan, ROC.ORCID http://orcid.org/0000-0003-2220-7574
Jian-Jhong WangDivision of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Liouying. No. 201, Taikang, Taikang Vil., Liuying Dist.736, Tainan City, Taiwan.
Chun-Te HuangDivision of Internal and Critical Care Medicine, Department of Critical Care Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
Pei-Chen WuDivision of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei, 10449, Taiwan.
Eric ChuehCase Western Reserve University, No. 10900 Euclid Ave., Cleveland, OH, 44106, USA.
Shih-Chieh Jeff ChuehCleveland Clinic Lerner College of Medicine and Glickman Urological and Kidney Institute, Cleveland Clinic, No. 9980, Carnegie Ave, Cleveland, OH, 44195, USA.
Kianoush KashaniDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, No. 200 First St. SW, Rochester, MN, 55905, USA. kashani.kianoush@mayo.edu.
Vin-Cent WuDivision of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Zhong-Zheng District, Taipei, 100, Taiwan. q91421028@ntu.edu.tw.
National Taiwan University Hospital · TWCase Western Reserve University · USChi Mei Medical Center · TWCleveland Clinic Lerner College of Medicine · USMackay Memorial Hospital · TWMayo Clinic · USSt. Mary's Medical Center · USTaichung Veterans General Hospital · TW

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlthough the optimal timing of initiation of renal replacement therapy (RRT) in critically ill patients with acute kidney injury has been extensively studied in the past, it is still unclear.

methodsIn this systematic review, we searched all related randomized controlled trials (RCTs) that directly compared earlier and later RRT published prior to June 25, 2016, from PubMed, MEDLINE, and EMBASE. We extracted the study characteristics and outcomes of all-cause mortality, RRT dependence, and intensive care unit (ICU) and hospital length of stay (LOS).

resultsWe identified 51 published relevant studies from 13,468 screened abstracts. Nine RCTs with 1627 participants were included in this meta-analysis. Earlier RRT was not associated with benefits in terms of mortality [relative risk (RR) 0.88, 95% confidence interval (CI) 0.68-1.14, p = 0.33] and RRT dependence (RR 0.81, 95% CI 0.46-1.42, p = 0.46). There were also no significant differences in the ICU and hospital LOS between patients who underwent earlier versus later RRT [standard means difference -0.08 (95% CI -0.26 to 0.09) and -0.11 (95% CI -0.37 to 0.16) day, respectively]. In subgroup analysis, earlier RRT was associated with a reduction in the in-hospital mortality among surgical patients (RR 0.78, 95% CI 0.64-0.96) and patients who underwent continuous renal replacement therapy (CRRT) (RR 0.80, 95% CI 0.67-0.96).

conclusionsCompared with later RRT, earlier initiation of RRT did not show beneficial impacts on patient outcomes. However, a lower rate of death was observed among surgical patients and in those who underwent CRRT. The included literature is highly heterogeneous and, therefore, potentially subject to bias. Further high-quality RCT studies are warranted.

Indexed as

Acute kidney injuryCAKSLength of stayMeta-analysisMortalityNSARFRenal replacement therapyTiming

Identifiers

PMID28382597
PMCPMC5382114
OpenAlexW2604405221

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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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.