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Table 1 Characteristics of included studies

From: Timing of renal replacement therapy initiation for acute kidney injury in critically ill patients: a systematic review of randomized clinical trials with meta-analysis and trial sequential analysis

Study

Country

Design and setting

Total no. of patients (male)/mean age (SD)

Criteria for RRT initiation

RRT modality

Median time of RRT initiation (IQR), h

SOFA scores at administration

Early

Delayed

Early

Delayed

Bagshaw [14]

Canada

Multicenter

Mixed population

2927 (1990)

64.6 + 14.9

within 12 h after the onset of KDIGO stage 2 or 3

Serum potassium ≥ 6 mmol/; pH ≤ 7.2; serum bicarbonate ≤ 12 mmol/L; severe respiratory failure; volume overload; persistent AKI ≥ 72 h

IHD, CRRT

6.1 [3.9,8.8]

31.1 [19.0,71.8]

11.7 + 3.6

Barbar [22]

France

Multicenter

Septic shock population

488 (296)

69 + 12.2

Within 12 h after the onset of failure stage of RIFLE

Serum potassium ≥ 6.5 mmol/; pH ≤ 7.15; severe pulmonary edema refractory to diuretics; no renal function recovery after 48 h

IHD, CRRT

7.6 [4.4,11.5]

51.5 [34.6,59.5]

12.3 + 2.9

Bouman [29]

Netherlands

Two-center

Mixed population

71 (42)

68.5 + 11.6

Within 12 h if urine output <  30 ml/h for 6 h; creatinine clearance of < 20 mL/min

Plasma urea level of > 40 mmol/L; potassium of > 6.5 mmol/L or severe pulmonary edema

LVHF

7 [5, 10]

41.8 [21.4,72]

10.4 ± 2.1

Combes [23]

France

Multicenter

Postcardiac surgery shock

224 (177)

59.5 ± 15.1

Persistent postoperative shock after cardiac surgery

AKI Network stage 3; serum urea > 36 mmol/L; life-threatening hyperkalemia

HVHF, CVVHDF, IHD

NA

NA

11.8 ± 2.9

Gaudry [20]

France

Multicenter

Mixed population

619 (409)

66.1 ± 13.9

KDIGO stage 3

Serum potassium > 6 mmol/L; severe pulmonary edema refractory to diuretics; pH < 7.15; serum urea > 40 mmol/L; oliguria > 72 h

IHD, CRRT

2 [1, 3]

57 [25,83]

10.9 ± 3.1

Jamale [28]

India

Single-center

Mixed population

208 (141)

42.4 ± 15.3

Serum urea nitrogen level  > 70 mg/dL; creatinine level > 7 mg/dL

Refractory hyperkalemia; volume overload; and acidosis; uremic nausea and anorexia

IHD

NA

NA

7.9 ± 3.2

Lumlertgul [25]

Thailand

Multicenter

Mixed population

118 (58)

67.1 ± 15.8

AKI (any stage of KDIGO) and no response to furosemide stress test

BUN ≥ 100 mg/dL; serum potassium > 6 mmol/L; serum bicarbonate < 12 mmol/L or pH < 7.15; PaO2/FiO2 ratio < 200; severe pulmonary edema

CVVH, PIRRT, IHD

2 [1, 3]

21 [17,49]

12 ± 3.7

Srisawat [26]

Thailand

Two-center

Mixed population

40 (22)

66.8 ± 15.9

AKI (any stage of RIFLE)

potassium > 6.2 mmol/L; pH < 7.2, severe pulmonary edema refractory to diuretics; persistent oliguria or anuria; serum urea > 40 mg/dL

CRRT

NA

NA

9.3 ± 3.6

Wald [27]

Canada

Multicenter

Mixed population

100 (72)

63.1 ± 12.8

At least two of the following: twofold increase in serum creatinine from baseline; urine output < 6 mL/kg in the preceding 12 h; whole-blood NGAL ≥ 400 ng/m

Serum potassium > 6.2 mmol/L; serum bicarbonate < 10 mmol/L, severe pulmonary edema; persistent AKI for > 72 h

IHD, CRRT, SLED

7.4 [6.1,9.6]

31.6 [22.8,59.5]

13 ± 2.8

Xia [30]

China

Single-center Sepsis population

60 (33)

66.4 ± 11.5

Sepsis and urinary NGAL  ≥ 1310 ng/mL

Serum potassium > 6.5 mmol/L; pH < 7.2; severe pulmonary edema

CRRT

NA

NA

9.6 ± 3.2

Zarbock [24]

Germany

Single-center

Mixed population

231 (146)

67 ± 13.1

Within 8 h of diagnosis of KDIGO stage 2

Within 12 h of diagnosis of KDIGO stage 3; or serum urea > 100 mg/dL; serum potassium > 6 mmol/L; serum magnesium > 4 mmol/L; urine < 200 mL per 12 h or anuria; organ edema refractory to diuretics

CRRT, SLED, IHD

6 [4, 7]

25.5 [18.8,40.3]

15.8 ± 2.3

  1. AKI acute kidney injury, KDIGO Kidney Disease Improving Global Outcomes classification, RIFLE risk, injury, failure, loss, and end-stage kidney disease classification system, IHD intermittent hemodialysis, CRRT continuous renal replacement therapy, LVHF low-volume hemofiltration, HVHF high-volume hemofiltration, CVVHDF continuous venovenous hemodiafiltration, BUN blood urea nitrogen, CVVH continuous venovenous hemofiltration, PIRRT prolonged intermittent renal replacement therapy, SLED sustained low-efficiency dialysis, NA not available, SD standard deviation