Methodology: 3.5/5
Usefulness: 2/5

Gaudry S, et al. Lancet. 2020 May 9;395(10235):1506-1515.

Question and Methods: Gaudry et al performed a systematic review and individual patient data meta-analysis of randomized control trials to compare the benefits of early versus delayed initiation of all types of renal replacement therapy (RRT) on 28-mortality in critically ill adults with acute kidney injury (AKI).
Findings: 10 studies (2143 patients) were identified in the systematic review of which 9 studies (1879 patients) were analyzed in the meta-analysis. There was 44% and 43% 28-day mortality for the delayed RRT and the early RRT groups, respectively, showing no significant difference in the strategies in individual or subgroup analyses.
Limitations: Agreement on criteria for ‘early’ vs ‘delayed’ strategies for RRT in critically ill adults with AKI and its multifactorial etiologies were both variable across medical centers and studies included in this SR and the benefit of either hard to parse out.

Interpretation: There is no mortality benefit to initiating early RRT in critically ill patients with acute kidney injury.

By: Dr. Alex Viau

Hans Rosenberg
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.