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Table 1 The characteristics of early and late RRT studies included in the meta-analysis

From: Early versus late initiation of renal replacement therapy impacts mortality in patients with acute kidney injury post cardiac surgery: a meta-analysis

Study Year Study design RRT modality Definition of early and late RRT Mortality at 28 days
Deaths/patients (n/n (%))
Total OR(95% CI) Quality score
Early RRT Late RRT Early RRT Late RRT
Bouma [23] 2002 RCT CRRT UOP <30 mL/h within 12 h Plasma urea level >40 mmol/L after 12 h 11/35 (31.4) 9/36 (25.0) 71 1.38 (0.49, 3.88) M
Combes [17] 2015 RCT CRRT/IHD RRT initiation within 24 h post cardiac surgery in shock requiring high-dose catecholamine Classic indication for RRT, life-threatening metabolic derangements 40/112 (35.7) 40/112 (35.7) 224 1.00 (0.58, 1.73) H
Crescenzi [18] 2015 RCT CRRT Within 12 h of UOP <0.5 mL/kg/h After 12 h on the basis of persistent (>6 h of UOP <0.5 mL/kg/h) oliguria 28/46 (60.9) 10/13 (76.9) 59 0.47 (0.11, 1.93) L
Demirkilic [24] 2004 Retrospective cohort CRRT RRT initiation within 24 h after surgery when UOP <100 mL within consecutive 8 h RRT initiation after 24 h post-surgery when Cr level exceeded 5 mg/dL or potassium level exceeded 5.5 mEq/L 8/34 (23.5) 15/27 (55.6) 61 0.25 (0.08, 0.74) 6
Durmaz [25] 2003 RCT IHD Serum Cr rise >10% from pre-op level within 48 h of surgery Serum Cr rise >50% from pre-op level or UOP <400 mL over 24 h of surgery 1/21 (4.8) 7/23 (30.4) 44 0.11 (0.01, 1.03) L
Elahi [26] 2004 Retrospective cohort CRRT RRT initiation within 24 h after surgery when UOP <100 mL within 8 h consecutively, despite furosemide infusion RRT initiation after 24 h post-surgery when urea ≥30 mmol/L, serum Cr ≥250 mol/L or serum K ≥6 mEq/L 8/36 (22.2) 12/28 (42.9) 64 0.38 (0.13, 1.13) 6
Fernandez [27] 2011 Retrospective cohort CRRT/IHD Within 72 h after surgery After 72 h post-surgery 54/101 (53.2) 82/102 (80.4) 203 0.28 (0.15, 0.52) 7
Helmut [28] 1987 Retrospective cohort IHD Before first hemodialysis within 48 h after surgery Within 48 h after the first hemodialysis 9/21 (42.9) 10/15 (66.7) 36 0.38 (0.09, 1.49) 9
Iyem [29] 2009 Prospective cohort CRRT RRT initiation within 48 h when UOP ≤0.5 mL/kg/h post open-heart surgery RRT initiation after 48 h when UOP ≤0.5 mL/ kg/h and 50% increase in baseline urea and Cr post open-heart surgery 5/95 (5.2) 6/90 (6.6) 185 0.78 (0.23, 2.64) 7
Ji [30] 2011 Retrospective cohort CRRT Within 12 h of UOP ≤0.5 mL/kg/h postoperatively 12 h after UOP ≤0.5 mL/kg/h postoperatively 3/34 (8.8) 9/24 (37.5) 58 0.16 (0.04, 0.68) 6
Kleinknecht [31] 1972 Retrospective cohort IHD Early and frequent hemodialysis to keep blood urea <200 mg/100 mL Blood urea more than 350 mg/100 mL or severe presence of electrolyte abnormality 4/10 (40.0) 5/10 (50.0) 20 0.67 (0.11, 3.92) 7
Manche [32] 2008 Retrospective cohort IHD RRT initiation within 48 h after surgery when UOP <0.5 mL/kg/min RRT initiation after 48 h post-surgery when all other supportive treatments failed 14/56 (25.0) 13/15 (87.0) 71 0.05 (0.01, 0.26) 6
Sugahara [33] 2004 RCT CRRT Within 12 h of UOP <30 mL/h After 12 h of UOP <20 mL/h 2/14 (14.3) 12/14 (85.7) 28 0.03 (0.00, 0.23) M
Szu-Yuan Li [19] 2014 Retrospective cohort CRRT Within 12 h of UOP <240 mL UOP <240 mL after 12 h 44/97 (61.9) 33/45 (82.2) 142 0.30 (0.14, 0.65) 8
Xiao-Mei Yang [20] 2016 Retrospective cohort IHD RRT initiation within 24 h after surgery when AKI present in absence of traditional indications for RRT RRT initiation after 24 h post-surgery when there were traditional indications for RRT 20/59 (33.9) 80/154 (51.9) 213 0.47 (0.25, 0.89) 7
  1. Abbreviations: RRT renal replacement therapy, Cr creatinine, UOP urine output, h hours, IHD intermittent hemodialysis, CRRT continuous renal replacement therapy, RCT randomized controlled trial, OR odds ratio, CI confidence interval, AKI acute kidney injury, pre-op preoperative, H high quality: low risk of bias, M, medium quality: unclear risk of bias, L, low quality: high risk of bias