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

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

Autor Seabra, Victor F. Google Scholar
Balk, Ethan M. Google Scholar
Liangos, Orfeas Google Scholar
Sosa, Marie Anne Google Scholar
Cendoroglo, Miguel Autor UNIFESP Google Scholar
Jaber, Bertrand L. Google Scholar
Instituição Caritas St Elizabeths Med Ctr
Universidade de São Paulo (USP)
Tufts Med Ctr
Universidade Federal de São Paulo (UNIFESP)
Resumo Background: 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.
Palavra-chave acute renal failure
ARF
dialysis
hemodialysis
continuous renal replacement therapy
timing
prophylactic
early
late
intensive
mortality
meta-analysis
Idioma Inglês
Data de publicação 2008-08-01
Publicado em American Journal of Kidney Diseases. Philadelphia: W B Saunders Co-Elsevier Inc, v. 52, n. 2, p. 272-284, 2008.
ISSN 0272-6386 (Sherpa/Romeo, fator de impacto)
Publicador Elsevier B.V.
Extensão 272-284
Fonte http://dx.doi.org/10.1053/j.ajkd.2008.02.371
Direito de acesso Acesso restrito
Tipo Artigo
Web of Science WOS:000257943400012
Endereço permanente http://repositorio.unifesp.br/handle/11600/30830

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