Qi Jiawei, Wu Wenwen, Wang Jingzhu, Guo Xin, Xia Chengyun
Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
Department of Clinical Medicine, North Sichuan Medical College, Nanchong, Sichuan, China.
PLoS One. 2025 Mar 25;20(3):e0320351. doi: 10.1371/journal.pone.0320351. eCollection 2025.
Acute kidney injury (AKI) is associated with high death rates and unfavorable outcomes. Previous studies evaluating the effect of the timing of CRRT therapy on the prognosis of patients with AKI have shown inconsistent results. Consequently, we aimed to assess the impact of continuous renal replacement therapy (CRRT) initiation on the outcomes of patients with AKI. This meta-analysis identified eligible randomized controlled trials (RCTs) via comprehensive searches of PubMed, Embase, and the Cochrane databases from their creation until June 1, 2024. Outcomes, including 28-, 60-, and 90-day mortality and adverse event incidence, were compared between the early and delayed CRRT groups post-randomization. Twelve RCTs (n = 1,244) were included. Meta-analysis indicated that early initiation of CRRT did not significantly affect 28-day mortality (RR 0.91 [0.79, 1.06]; p = 0.23; I2 = 0). Early CRRT initiation correlated with a shorter length of ICU stay [MD -3.24 (-5.14, -1.35); p = 0.0008; I2 = 36%] but did not significantly affect hospital stay duration [MD -7.00 (-14.60, 0.60); p = 0.07; I2 = 38%]. The early initiation of CRRT was associated with a significant reduction in RRT dependency at discharge [RR 0.57 (0.32, 0.99); P = 0.05; I2 = 0%; P = 0.47]. Compared to delayed CRRT, early CRRT was associated with higher incidence rates of hypotension [RR 1.26 (1.06, 1.50); p = 0.008; I2 = 0%], thrombocytopenia [RR 1.53 (1.11, 2.10); p = 0.009; I2 = 0%], and hypophosphatemia [RR 3.35 (2.18, 5.15); p < 0.00001; I2 = 11%]. Our findings suggest that although early CRRT initiation is associated with short intensive care unit stays and reduced RRT dependence, it has no significant effect on mortality and is in fact associated with higher incidence rates of hypotension, thrombocytopenia, and hypophosphatemia. Therefore, early CRRT should be used clinically with caution and consideration of potential adverse effects.
急性肾损伤（AKI）与高死亡率和不良预后相关。先前评估连续性肾脏替代疗法（CRRT）治疗时机对AKI患者预后影响的研究结果并不一致。因此，我们旨在评估开始进行连续性肾脏替代疗法（CRRT）对AKI患者预后的影响。这项荟萃分析通过全面检索PubMed、Embase和Cochrane数据库，从其创建至2024年6月1日，确定了符合条件的随机对照试验（RCT）。比较随机分组后早期和延迟CRRT组的结局，包括28天、60天和90天死亡率以及不良事件发生率。纳入了12项RCT（n = 1244）。荟萃分析表明，早期开始CRRT对28天死亡率没有显著影响（风险比[RR] 0.91 [0.79, 1.06]；p = 0.23；I² = 0）。早期开始CRRT与缩短重症监护病房（ICU）住院时间相关[平均差（MD）-3.24（-5.14, -1.35）；p = 0.0008；I² = 36%]，但对住院时间没有显著影响[MD -7.00（-14.60, 0.60）；p = 0.07；I² = 38%]。早期开始CRRT与出院时对肾脏替代治疗（RRT）的依赖显著降低相关[RR 0.57（0.32, 0.99）；P = 0.05；I² = 0%；P = 0.47]。与延迟CRRT相比，早期CRRT与低血压[RR 1.26（1.06, 1.50）；p = 0.008；I² = 0%]、血小板减少症[RR 1.53（1.11, 2.10）；p = 0.009；I² = 0%]和低磷血症[RR 3.35（2.18, 5.15）；p < 0.00001；I² = 11%]的发生率较高相关。我们的研究结果表明，虽然早期开始CRRT与缩短重症监护病房住院时间和降低对RRT的依赖相关，但对死亡率没有显著影响，实际上与低血压、血小板减少症和低磷血症的发生率较高相关。因此，临床上应谨慎使用早期CRRT，并考虑潜在的不良反应。
