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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorBESEN, Bruno Adler Maccagnan Pinheiro
dc.contributor.authorROMANO, Thiago Gomes
dc.contributor.authorMENDES, Pedro Vitale
dc.contributor.authorGALLO, Cesar Albuquerque
dc.contributor.authorZAMPIERI, Fernando Godinho
dc.contributor.authorNASSAR JR., Antonio Paulo
dc.contributor.authorPARK, Marcelo
dc.identifier.citationJOURNAL OF INTENSIVE CARE MEDICINE, v.34, n.9, p.714-722, 2019
dc.description.abstractObjective: Early initiation of renal replacement therapy (RRT) effect on survival and renal recovery of critically ill patients is still uncertain. We aimed to systematically review current evidence comparing outcomes of early versus late initiation of RRT in critically ill patients. Methods: We searched the Medline (via Pubmed), LILACS, Science Direct, and CENTRAL databases from inception until November 2016 for randomized clinical trials (RCTs) or observational studies comparing early versus late initiation of RRT in critically ill patients. The primary outcome was mortality. Duration of mechanical ventilation, intensive care unit (ICU) length of stay (LOS), hospital LOS, and renal function recovery were secondary outcomes. Meta-analysis and trial sequential analysis (TSA) were used for the primary outcome. Results: Sixty-two studies were retrieved and analyzed, including 11 RCTs. There was no difference in mortality between early and late initiation of RRT among RCTs (odds ratio [OR] = 0.78; 95% confidence interval [CI]: 0.52-1.19; I-2 = 63.1%). Trial sequential analysis of mortality across all RCTs achieved futility boundaries at both 1% and 5% type I error rates, although a subgroup analysis of studies including only acute kidney injury patients was not conclusive. There was also no difference in time on mechanical ventilation, ICU and hospital LOS, or renal recovery among studies. Early initiation of RRT was associated with reduced mortality among prospective (OR = 0.69; 95% CI: 0.49-0.96; I-2 = 85.9%) and retrospective (OR = 0.61; 95% CI: 0.41-0.92; I-2 = 90.9%) observational studies, both with substantial heterogeneity. However, subgroup analysis excluding low-quality observational studies did not achieve statistical significance. Conclusion: Pooled analysis of randomized trials indicates early initiation of RRT is not associated with lower mortality rates. The potential benefit of reduced mortality associated with early initiation of RRT was limited to low-quality observational studies.eng
dc.relation.ispartofJournal of Intensive Care Medicine
dc.subjectrenal replacement therapyeng
dc.subjectcritical illnesseng
dc.subjectintensive care uniteng
dc.subjectmultiorgan dysfunctioneng
dc.subjectacute kidney injuryeng
dc.subject.othercontinuous venovenous hemofiltrationeng
dc.titleEarly Versus Late Initiation of Renal Replacement Therapy in Critically Ill Patients: Systematic Review and Meta-Analysiseng
dc.rights.holderCopyright SAGE PUBLICATIONS INCeng
dc.subject.wosCritical Care Medicineeng
dc.type.versionpublishedVersioneng, Thiago Gomes:ABC Med Sch, Nephrol Dept, Santo Andre, Brazil; Hosp Sirio Libanes, Res Inst, Sao Paulo, Brazil, Fernando Godinho:HCor Hosp Coracao, Res Inst, Sao Paulo, Brazil; Hosp Alemao Oswaldo Cruz, Intens Care Unit, Sao Paulo, Brazil
hcfmusp.publisher.cityTHOUSAND OAKSeng
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Artigos e Materiais de Revistas Científicas - HC/ICHC
Instituto Central - HC/ICHC

Artigos e Materiais de Revistas Científicas - LIM/51
LIM/51 - Laboratório de Emergências Clínicas

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