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Table 1 Characteristics of included comparative studies

From: Accelerated versus standard initiation of renal replacement therapy for critically ill patients with acute kidney injury: a systematic review and meta-analysis of RCT studies

References

Population setting and site

Nation, continence

Patients (early/late)

WWS*

Age

Male (%)

HTN/DM/HF/CKD (%)

Sepsis (%)

Definition of "Accelerated"

Definition of "Standard"

RRT modality

Primary outcome

Bouman et al. [16]

Multi-center mixed

Netherland

71 (35/36)

Yes

68.4

59.2

NA

N/A

Within 12 h after fulfilling the following criteria: UOP < 30 mL/h and CCr < 20 mL/min on 3-h sample

When the patient fulfilled the conventional criteria for RRT: BUN > 40 mmol/L, K > 6.5 mmol/L or severe pulmonary edema (CVP or pulmonary artery occlusion pressure of 16 mm Hg and lung edema with positive end expiratory pressure of 10 cm H2O and PO2/FIO2 ratio of 150 mm Hg

CRRT

In-hospital mortality, In-ICU mortality, 28-day mortality

Sugahara et al. [17]

Single-center, surgical

Japan

28 (14/14)

No

64.5

64.3

57.0/38.5/NA/NA

N/A

Within 12 h of UOP < 30 mL/h or < 750 mL/day

After 12 h of UOP < 20 mL/h or urine output < 500 mL/day

CRRT

14-day mortality

Wald et al. [18]

Multi-center, mixed

Canada

100 (48/52)

Yes

63.1

72.0

53.0/39.0/11.0/NA

56.0

Within 12 h of fulfilling eligibility: at least two of the following: twofold increase in serum Cr from baseline; UOP < 6 mL/kg in the preceding 12 h; whole-blood NGAL > 400 ng/mL

Severe hyperkalemia (> 6 mmol/L); severe pulmonary edema; severe metabolic acidosis (serum bicarbonate < 10 mmol/L)

Mixed (IHD/CRRT/SLED)

In-hospital mortality; In-ICU mortality; 90-day mortality

Zarbock et al. [19]

Single-center, surgical

Germany

231 (112/119)

Yes

67.0

63.2

81.8/19.5/41.6/40.7

32.5

KDIGO Stage 2 AKI (within 8 h) and plasma NGAL > 150 ng/mL

KDIGO stage 3

CRRT

30-/60-/90-day mortality

Gaudry et al. [7]

Multi-center, mixed

France

619 (311/308)

Yes

66.2

65.4

53.0/26.3%/9.0/9.7

79.8

KDIGO Stage 3 AKI (within 6 h)

Severe hyperkalemia (> 6 mmol/L); severe pulmonary edema refractory to diuretics; severe acidosis (pH < 7.15); serum urea > 40 mmol/L; oligo-anuria > 72 h

Mixed (IHD/CRRT)

60-/90-day mortality

Srisawat et al. [20]

Single-center, mixed

Thailand

40 (20/20)

Yes

66.8

55.0

NA

72.5

AKI, any RIFLE stage

Severe metabolic acidosis (pH < 7–20); severe hyperkalemia (> 6 2 mmol/L); severe pulmonary edema refractory to diuretics; persistent oliguria or anuria; serum urea > 40 mg/dL

CRRT

28-day mortality

Lumlertgul et al. [21]

Multicenter, mixed

Thailand

118 (58/60)

Yes

67.1

46.2

44.9/24.6/NA/NA

58.5

Furosemide stress test-nonresponsive patients (UOP < 200 mL in 2 h) (initiation within 6 h); AKI (any stage of KDIGO)

Serum urea > 100 mg/dL; severe hyperkalemia (> 6 mmol/L); severe metabolic acidosis (pH < 715); severe pulmonary edema

CRRT

28-day mortality

Barbar et al. [8]

Multicenter, mixed

France

477 (239/238)

Yes

69.0

60.7

57.8/30.5/8.2/15.6

100.0

Within 12 h after documentation of RIFLE-F

Severe hyperkalemia (> 6 5 mmol/L); severe pulmonary edema refractory to diuretics; severe metabolic acidosis (pH < 715); no renal function recovery after 48 h

Mixed

90-day mortality

Yang et al. [22]

Single-center, mixed

China

142 (71/71)

No

56.7

58.5

37.3/45.8/NA/NA

100

Within 24 h of ICU entry

After 48 h of ICU entry

CRRT

28-day mortality

STARRT-AKI [9]

Multicenter, mixed

Multiple

2927 (1465/1462)

Yes

64.7

68.0

55.9/30.7/13.9/43.9

57.7

Within 12 h of fulfilling eligibility: at least two of the following: twofold increase in serum Cr from baseline; UOP < 6 mL/kg in the preceding 12 h; whole-blood NGAL > 400 ng/mL

Until the development of one or more of the following criteria: a serum potassium level > 6.0 mmol/L, a pH < 7.20 or a serum bicarbonate < 12 mmol/L, severe respiratory failure based on a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of < 200 and clinical perception of volume overload, or persistent AKI for at least 72 h after randomization

Mixed

90-day mortality

  1. AKI, acute kidney injury; CCr, creatinine clearance rate; CKD, chronic kidney disease; Cr, creatinine; CRRT, continuous renal replacement therapy; DM, diabetic mellitus; HTN, hypertension; HF, heart failure; ICU, intensive care unit; IHD. Intermittent hemodialysis; KDIGO, Kidney Disease Improving Global Outcomes; N/A, not available; NGAL, neutrophil gelatinase-associated lipocalin; pre-OP, pre-operation; RIFLE, Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease; RRT, renal replacement therapy; SLED, Sustained low efficiency dialysis; UOP, urine output; WWS, watchful waiting strategy
  2. *Study design with watchful waiting strategy