Outcome of early versus late CRRT in critically ill patients with acute kidney injury
Keywords:
Acute kidney injury, Early continuous renal replacement therapy, Late continuous renal replacement therapyAbstract
AKI is a common but serious complication in acutely unwell patients and results in high morbidity and mortality. This review considers the issue of the effects of early versus late initiation of CRRT on patient outcomes. Early CRRT may be defined as inception shortly after the diagnosis of AKI has been established, especially in the case of signs related to fluid overload or severe electrolyte disturbances. Early CRRT would offer potential benefits like an improved survival rate, complications avoided as regards pulmonary edema and cardiac failure, better nutritional support, and a reduced need for more intensive renal replacement support later. On the other hand, late CRRT is performed in clinical practice when more severe AKI manifestations have occurred, which are usually associated with higher mortality and complications due to fluid overload and metabolic disturbances. Key studies referred to report worse outcomes for late initiation, considering higher multi-organ failure and prolongation of the length of stay in the ICU. Most observational studies report better outcomes with early CRRT, while randomized controlled trials exhibit variable results, with some finding no clinically significant difference in mortality between the timing of early and delayed initiation.
Downloads
References
Fang, J., Wang, M., Gong, S., Cui, N., & Xu, L. (2022). Increased 28‐day mortality due to fluid overload prior to continuous renal replacement in sepsis associated acute kidney injury. Therapeutic Apheresis and Dialysis, 26(2), 288–296. DOI: https://doi.org/10.1111/1744-9987.13727
Liu, C., Peng, Z., Dong, Y., Li, Z., Song, X., Liu, X., Andrijasevic, N. M., Gajic, O., Albright Jr, R. C., & Kashani, K. B. (2021). Continuous renal replacement therapy liberation and outcomes of critically ill patients with acute kidney injury. Mayo Clinic Proceedings, 96(11), 2757–2767. DOI: https://doi.org/10.1016/j.mayocp.2021.05.031
Chatterjee, R., Chhabra, P. H., Kulshrestha, V., & Verma, A. (2023). Comparison of early continuous hemodiafiltration vs. delayed continuous hemodiafiltration in patients of acute kidney injury (AKI) with septic shock. International Journal of Science and Research Archive, 10(2), 107–112. DOI: https://doi.org/10.30574/ijsra.2023.10.2.0751
Chen, W., Cai, L., Zhang, Z., Tao, L., Wen, Y., Li, Z., Li, L., Ling, Y., Li, J., & Xing, R. (2021a). Protocol: The timing of continuous renal replacement therapy initiation in sepsis-associated acute kidney injury in the intensive care unit: the CRTSAKI Study (Continuous RRT Timing in Sepsis-associated AKI in ICU): study protocol for a multicentre, randomised controlled trial. BMJ Open, 11(2).
Zhang, L., Chen, D., Tang, X., Li, P., Zhang, Y., & Tao, Y. (2020). Timing of initiation of renal replacement therapy in acute kidney injury: an updated meta-analysis of randomized controlled trials. Renal Failure, 42(1), 77–88. DOI: https://doi.org/10.1080/0886022X.2019.1705337
Peng, S., Wang, H.-Y., Sun, X., Li, P., Ye, Z., Li, Q., Wang, J., Shi, X., Liu, L., & Yao, Y. (2020). Early versus late acute kidney injury among patients with COVID-19—a multicenter study from Wuhan, China. Nephrology Dialysis Transplantation, 35(12), 2095–2102. DOI: https://doi.org/10.1093/ndt/gfaa288
Pan, H.-C., Chen, Y.-Y., Tsai, I.-J., Shiao, C.-C., Huang, T.-M., Chan, C.-K., Liao, H.-W., Lai, T.-S., Chueh, Y., & Wu, V.-C. (2021). Accelerated versus standard initiation of renal replacement therapy for critically ill patients with acute kidney injury: a systematic review and meta-analysis of RCT studies. Critical Care, 25, 1–15. DOI: https://doi.org/10.1186/s13054-020-03434-z
Lin, J., Ji, X. J., Wang, A. Y., Liu, J. F., Liu, P., Zhang, M., Qi, Z. L., Guo, D. C., Bellomo, R., & Bagshaw, S. M. (2021). Timing of continuous renal replacement therapy in severe acute kidney injury patients with fluid overload: a retrospective cohort study. Journal of Critical Care, 64, 226–236. DOI: https://doi.org/10.1016/j.jcrc.2021.04.017
An, J. N., Kim, S. G., & Song, Y. R. (2021). When and why to start continuous renal replacement therapy in critically ill patients with acute kidney injury. Kidney Research and Clinical Practice, 40(4), 566. DOI: https://doi.org/10.23876/j.krcp.21.043
Bouchard, J., & Mehta, R. L. (2022). Timing of kidney support therapy in acute kidney injury: what are we waiting for? American Journal of Kidney Diseases, 79(3), 417–426. DOI: https://doi.org/10.1053/j.ajkd.2021.07.014
Agapito Fonseca, J., Gameiro, J., Marques, F., & Lopes, J. A. (2020). Timing of initiation of renal replacement therapy in sepsis-associated acute kidney injury. Journal of Clinical Medicine, 9(5), 1413. DOI: https://doi.org/10.3390/jcm9051413
Tuna, V., Senturk, E., Orhun, G., Polat, O., Anakli, I., Alay, G., Celiksoy, E., Kilic, M., Mutlu, M., & Figen, E. (2024). Effects of early and late continuous renal replacement therapy on intensive care unit mortality in patients with COVID-19 with acute respiratory distress syndrome and acute kidney injury: a comparative study. Renal Replacement Therapy, 10(1), 35. DOI: https://doi.org/10.1186/s41100-024-00549-9
Li, J. H., Cai, J. H., Wang, M. J., Zeng, Z., Du, H. Y., Lu, J., Li, Z., Zeng, X. M., & Tang, Q. (2023). Early strategy vs. late initiation of renal replacement therapy in adult patients with acute kidney injury: an updated systematic review and meta-analysis of randomized controlled trials. Eur Rev Med Pharmacol Sci, 27(13), 6046–6057.
Chen, W., Cai, L., Zhang, Z., Tao, L., Wen, Y., Li, Z., Li, L., Ling, Y., Li, J., & Xing, R. (2021b). The timing of continuous renal replacement therapy initiation in sepsis-associated acute kidney injury in the intensive care unit: the CRTSAKI Study (Continuous RRT Timing in Sepsis-associated AKI in ICU): study protocol for a multicentre, randomised controlled trial. BMJ Open, 11(2), e040718. DOI: https://doi.org/10.1136/bmjopen-2020-040718
Tekdöş Şeker, Y., Çukurova, Z., Özel Bilgi, D., & Hergünsel, O. (2020). Prognostic impact of early versus late initiation of renal replacement therapy based on early warning algorithm in critical care patients with acute kidney injury. Therapeutic Apheresis and Dialysis, 24(4), 445–452. DOI: https://doi.org/10.1111/1744-9987.13449
Published
How to Cite
Issue
Section
Copyright (c) 2024 International journal of health sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.
