الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Acute kidney injury (AKI) is a common potentially fatal complication of illnesses among 1% of the community-based population, 8–15% of hospitalized patients, and up to 50% of critically ill patients admitted to the intensive care unit (ICU) (Clark et al., 2012).
AKI carries increased risk of morbidity and mortality and adds to the health- care cost, even in mild temporary form (Pannu et al., 2013).
Renal replacement therapy (RRT) remains the primary supportive management strategy for patients with severe AKI.
In recent decades, the timing of RRT initiation has been evaluated in different population types (e. g., surgical or medical patients). Variability in the definitions of AKI and RRT timing has resulted in contradicting conclusions among the various studies (Carl et al., 2010).
Previous systematic analyses regarding the optimal timing of RRT initiation were unable to draw definitive conclusions owing to the scarcity of large-scale randomized controlled trials (RCTs), non-standardized triggers for RRT initiation, and heterogeneities of population and study design. In summary, while the observational studies tended to show more beneficial effects for earlier RRT, clinical trials were unable to replicate these findings (Gaudry et al., 2016).
We conducted this updated systematic review and meta-analysis To investigate the impact of timing the initiation of renal replacement therapy (RRT) on clinical outcomes in critically ill patients with acute kidney injury (AKI), focusing on the randomized controlled trials in this field.
We enrolled 9 RCTs (since 2000 till 2019) with a total of 1636 patients in this Meta-analysis randomized as early and late groups focusing on mortality up to 90 days, intensive care unit LOS among survivors and non-survivors, hospital LOS among survivors and non-survivors, renal function recovery and renal replacement therapy dependence.
The most fundamental differences among the trials were the large differences concerning the timing of RRT initiation among studies. Urine output, serum creatinine, serum urea nitrogen and AKI stages were not used unified in the individual studies to define the early and late RRT strategies.
Our meta-analysis revealed that the “early” initiation of RRT in critically ill patients did not result in a reduced Mortality.
A pooled analysis of secondary outcomes Showed no significant difference in Intensive care unit Length of stay (LOS) or hospital Length of stay(LOS) between early and late RRT group for survivors or non- survivors.
A pooled analysis also demonstrated no significant change in renal function recovery and RRT dependence.
Further randomized clinical trials are still needed to confirm the best timing of RRT.