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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