{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:19:45Z","timestamp":1793395185256,"version":"4.5.0"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>\n                    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\u2009=\u20091,244) 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 =\u2009 0.23; I\n                    <jats:sup>2<\/jats:sup>\n                    =\u2009 0). Early CRRT initiation correlated with a shorter length of ICU stay [MD -3.24 (-5.14, -1.35); p\u2009=\u20090.0008; I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200936%] but did not significantly affect hospital stay duration [MD -7.00 (-14.60, 0.60); p\u2009=\u20090.07; I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200938%]. The early initiation of CRRT was associated with a significant reduction in RRT dependency at discharge [RR 0.57 (0.32, 0.99); P\u2009=\u20090.05; I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090%; P\u2009=\u20090.47]. Compared to delayed CRRT, early CRRT was associated with higher incidence rates of hypotension [RR 1.26 (1.06, 1.50); p\u2009=\u20090.008; I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090%], thrombocytopenia [RR 1.53 (1.11, 2.10); p\u2009=\u20090.009; I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090%], and hypophosphatemia [RR 3.35 (2.18, 5.15); p\u2009&lt;\u20090.00001; I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200911%]. 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.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0320351","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T18:11:33Z","timestamp":1742926293000},"page":"e0320351","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Selection of timing of continuous renal replacement therapy in patients with acute kidney injury: A meta-analysis of randomized controlled trials"],"prefix":"10.1371","volume":"20","author":[{"given":"Jiawei","family":"Qi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenwen","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingzhu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8203-6248","authenticated-orcid":true,"given":"Chengyun","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"issue":"8","key":"pone.0320351.ref001","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1007\/s00134-015-3934-7","article-title":"Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study","volume":"41","author":"EAJ Hoste","year":"2015","journal-title":"Intensive Care Med"},{"issue":"3","key":"pone.0320351.ref002","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1681\/ASN.2017080882","article-title":"Causes of Death after a Hospitalization with AKI","volume":"29","author":"SA Silver","year":"2018","journal-title":"J Am Soc Nephrol"},{"issue":"10","key":"pone.0320351.ref003","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1038\/s41581-018-0052-0","article-title":"Global epidemiology and outcomes of acute kidney injury","volume":"14","author":"EAJ Hoste","year":"2018","journal-title":"Nat Rev Nephrol"},{"issue":"1","key":"pone.0320351.ref004","doi-asserted-by":"crossref","first-page":"R72","DOI":"10.1186\/cc10061","article-title":"A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis","volume":"15","author":"CJ Karvellas","year":"2011","journal-title":"Crit Care"},{"issue":"12","key":"pone.0320351.ref005","first-page":"CD010612","article-title":"Timing of renal replacement therapy initiation for acute kidney injury","volume":"12","author":"AII Fayad","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"issue":"10235","key":"pone.0320351.ref006","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1016\/S0140-6736(20)30531-6","article-title":"Delayed versus early initiation of renal replacement therapy for severe acute kidney injury: a systematic review and individual patient data meta-analysis of randomised clinical trials","volume":"395","author":"S Gaudry","year":"2020","journal-title":"Lancet"},{"issue":"1","key":"pone.0320351.ref007","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s13054-020-03451-y","article-title":"Timing of renal replacement therapy initiation for acute kidney injury in critically ill patients: a systematic review of randomized clinical trials with meta-analysis and trial sequential analysis","volume":"25","author":"X Li","year":"2021","journal-title":"Crit Care"},{"issue":"11","key":"pone.0320351.ref008","first-page":"CD010612","article-title":"Timing of kidney replacement therapy initiation for acute kidney injury","volume":"11","author":"AI Fayad","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"issue":"10","key":"pone.0320351.ref009","doi-asserted-by":"crossref","first-page":"2205","DOI":"10.1097\/00003246-200210000-00005","article-title":"Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial","volume":"30","author":"CSC Bouman","year":"2002","journal-title":"Crit Care Med"},{"issue":"10","key":"pone.0320351.ref010","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1164\/rccm.201503-0516OC","article-title":"Early High-Volume Hemofiltration versus Standard Care for Post-Cardiac Surgery Shock. The HEROICS Study","volume":"192","author":"A Combes","year":"2015","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0320351.ref011","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.jcrc.2017.08.029","article-title":"The effect of early renal replacement therapy guided by plasma neutrophil gelatinase associated lipocalin on outcome of acute kidney injury: A feasibility study","volume":"43","author":"N Srisawat","year":"2018","journal-title":"J Crit Care"},{"issue":"20","key":"pone.0320351.ref012","doi-asserted-by":"crossref","first-page":"2190","DOI":"10.1001\/jama.2016.5828","article-title":"Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury: The ELAIN Randomized Clinical Trial","volume":"315","author":"A Zarbock","year":"2016","journal-title":"JAMA"},{"issue":"1","key":"pone.0320351.ref013","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1186\/s13054-018-2021-1","article-title":"Early versus standard initiation of renal replacement therapy in furosemide stress test non-responsive acute kidney injury patients (the FST trial)","volume":"22","author":"N Lumlertgul","year":"2018","journal-title":"Crit Care"},{"key":"pone.0320351.ref014","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.resuscitation.2019.03.045","article-title":"Hemodynamic efficiency of hemodialysis treatment with high cut-off membrane during the early period of post-resuscitation shock: The HYPERDIA trial","volume":"140","author":"G Geri","year":"2019","journal-title":"Resuscitation"},{"issue":"3","key":"pone.0320351.ref015","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1097\/CCM.0b013e3181962316","article-title":"Impact of continuous venovenous hemofiltration on organ failure during the early phase of severe sepsis: a randomized controlled trial","volume":"37","author":"D Payen","year":"2009","journal-title":"Crit Care Med"},{"issue":"4","key":"pone.0320351.ref016","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1111\/j.1492-7535.2004.80404.x","article-title":"Early start on continuous hemodialysis therapy improves survival rate in patients with acute renal failure following coronary bypass surgery","volume":"8","author":"S Sugahara","year":"2004","journal-title":"Hemodial Int"},{"issue":"07","key":"pone.0320351.ref017","first-page":"605","article-title":"Effect of urinary NGAL on the timing of renal replacement therapy in patients with acute renal injury associated with sepsis","volume":"44","author":"Y Xia","year":"2019","journal-title":"Med J Chin PLA"},{"key":"pone.0320351.ref018","unstructured":"Yang T, Zhou R, Yao H, Peng L. 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