Timing of renal replacement therapy initiation in acute renal failure: A meta-analysis

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dc.contributor.authorSeabra, Victor F.
dc.contributor.authorBalk, Ethan M.
dc.contributor.authorLiangos, Orfeas
dc.contributor.authorSosa, Marie Anne
dc.contributor.authorCendoroglo, Miguel [UNIFESP]
dc.contributor.authorJaber, Bertrand L.
dc.contributor.institutionCaritas St Elizabeths Med Ctr
dc.contributor.institutionUniversidade de São Paulo (USP)
dc.contributor.institutionTufts Med Ctr
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.date.accessioned2016-01-24T13:51:36Z
dc.date.available2016-01-24T13:51:36Z
dc.date.issued2008-08-01
dc.description.abstractBackground: Some studies have suggested that early institution of renal replacement therapy (RRT) might be associated with improved outcomes in patients with acute renal failure (ARF).Study Design: A systematic review and meta-analysis of randomized controlled trials and cohort comparative studies to assess the effect of early RRT on mortality in patients with ARF.Setting & Population: Hospitalized adult patients with ARF.Selection Criteria for Studies: We searched several databases for studies that compared the effect of early and late RRT initiation on mortality in patients with ARF We included studies of various designs.Intervention: Early RRT as defined in the individual studies.Outcomes: the primary outcome measure was the effect of early RRT on mortality stratified by study design. the pooled risk ratio (RR) for mortality was compiled using a random-effects model. Heterogeneity was evaluated by means of subgroup analysis and meta-regression.Results: We identified 23 studies (5 randomized or quasi-randomized controlled trials, 1 prospective and 16 retrospective comparative cohort studies, and 1 single-arm study with a historic control group). By using meta-analysis of randomized trials, early RRT was associated with a nonsignificant 36% mortality risk reduction (RR, 0.64; 95% confidence interval, 0.40 to 1.05; P = 0.08). Conversely, in cohort studies, early RRT was associated with a statistically significant 28% mortality risk reduction (RR, 0.72; 95% confidence interval, 0.64 to 0.82; P < 0.001). the overall test for heterogeneity among cohort studies was significant (P = 0.005). Meta-regression yielded no significant associations; however, early dialysis therapy was associated more strongly with lower mortality in smaller studies (n < 100) by means of subgroup analysis.Limitations: Paucity of randomized controlled trials, use of variable definitions of early RRT, and publication bias preclude definitive conclusions.Conclusion: This hypothesis-generating meta-analysis suggests that early initiation of RRT in patients with ARF might be associated with improved survival, calling for an adequately powered randomized controlled trial to address this question.en
dc.description.affiliationCaritas St Elizabeths Med Ctr, Dept Med, Boston, MA 02135 USA
dc.description.affiliationUniv São Paulo, Hosp Clin, Div Nephrol, São Paulo, Brazil
dc.description.affiliationTufts Med Ctr, Inst Clin Res & Hlth Policy Studies, Boston, MA USA
dc.description.affiliationUniversidade Federal de São Paulo, Div Nephrol, São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Div Nephrol, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent272-284
dc.identifierhttp://dx.doi.org/10.1053/j.ajkd.2008.02.371
dc.identifier.citationAmerican Journal of Kidney Diseases. Philadelphia: W B Saunders Co-Elsevier Inc, v. 52, n. 2, p. 272-284, 2008.
dc.identifier.doi10.1053/j.ajkd.2008.02.371
dc.identifier.issn0272-6386
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/30830
dc.identifier.wosWOS:000257943400012
dc.language.isoeng
dc.publisherElsevier B.V.
dc.relation.ispartofAmerican Journal of Kidney Diseases
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.rights.licensehttp://www.elsevier.com/about/open-access/open-access-policies/article-posting-policy
dc.subjectacute renal failureen
dc.subjectARFen
dc.subjectdialysisen
dc.subjecthemodialysisen
dc.subjectcontinuous renal replacement therapyen
dc.subjecttimingen
dc.subjectprophylacticen
dc.subjectearlyen
dc.subjectlateen
dc.subjectintensiveen
dc.subjectmortalityen
dc.subjectmeta-analysisen
dc.titleTiming of renal replacement therapy initiation in acute renal failure: A meta-analysisen
dc.typeinfo:eu-repo/semantics/article
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