Timing of continuous renal replacement therapy in patients with septic AKI A systematic review and meta-analysis

Background: The effects of early continuous renal replacement therapy (CRRT) on mortality in patients with septic acute kidney injury (AKI) remain controversial. A systematic review and meta-analysis was performed to investigate the impact of timing of CRRT on clinical outcomes in patients with septic AKI. Methods: The PubMed, Cochrane, and Embase databases were searched from inception to the 31st of March 2019, to identify trials that assessed the timing of initiation of CRRT in patients with septic AKI. Results: Five trials including 900 patients were included. The results of this meta-analysis showed that there was no significant difference between 28-day mortality (odds ratio = 0.76; 95% CI, 0.58-1.00; P=.05) and 90-day mortality(odds ratio=0.79; 95% CI, 0.59-1.06; P=.12) of early and late initiation of CRRT group. In addition, compared with late initiation strategy, early initiation showed no significant advantage in length of stay in ICU (Mean difference=-0.9; 95% CI, -2.37 to 0.57; P=.23) and length of stay in hospital (Mean difference=-1.43; 95% CI, -5.28 to 2.41; P=.47). Conclusion: Our meta-analysis revealed that early initiation of CRRT could not reduce mortality in patients with septic AKI. The study also showed no significant difference in ICU length of stay or hospital length of stay between early and late CRRT group. To achieve optimal timing of CRRT for septic AKI, large multicenter randomized trials with better design are still needed.