In this context, observational studies have shown a tendency towards improved renal recovery under continuous hemofiltration, whereas a recent meta-analysis (excluding observational studies) and RCTs showed no difference [184,185,186,187]

In this context, observational studies have shown a tendency towards improved renal recovery under continuous hemofiltration, whereas a recent meta-analysis (excluding observational studies) and RCTs showed no difference [184,185,186,187]. AKI staging, issues and pitfalls of the determination of kidney function and RRT timing, as well as the potential harm reflected by unnecessary RRT. A better Clindamycin Phosphate understanding is mandatory to improve future study designs and avoid unnecessary RRT for higher patient safety and lower health care costs. = 0.790)Zarbock et al., 2016 [126]RCT112/119Within Clindamycin Phosphate 8 h of KDIGO stage 2 diagnosisWithin 12 h of stage 3 diagnosisBUN 38.5 mg/dL = 0.030)Wald et al., 2015 [125]RCT48/33Within 12 h after fulfilling study criteriaPotassium 6 mmol/L, bicarbonate 10 mmol/L, Horowitz 200+ infiltrates X-rayUrea 115.9 mg/dL = 0.920)Jamale et al., 2013 [116]RCT102/106BUN 70 mg/dL or SCr 7 mg/dLClinically indicated or jugged by nephrologistBUN 71.7 mg/dL = 0.200)Sugahara et al., 2004 [131]RCT14/143h after UO 30 mL/h2 h after UO 20 mL/hSCr 2.9 mg/dLSCr 3.0 mg/dLSurvival 86%/14%, = 0.010)Durmaz et al., 2003 [132]RCT21/2310% increase of SCr after surgery50% increase or UO 400 mL/24 hBUN 53.7 mg/dL = 0.048)Bouman et al., 2002 [133]RCT35/36within 12 h: UO 30 mL/h and 3 h CrCl 20 mL/minUrea 40 mmol/L or K 6.5 mmol/L or severe pulmonary edemaUrea 17.1 mmol/LUrea 37.4 mmol/LSurvival 67%/75% = 0.800)Vaara et al., 2014 [123]Prospective cohort105/134RRT without classic indications = pre-emptiveClassic MRC1 RRT indicationsUrea 19.1 mmol/L = 0.010)Leite et al., 2013 [124]Prospective cohort64/86 24 h after AKIN 324 h after AKIN 3Urea 100.1 mg/dL = 0.002)Bagshaw et al., 2009 [134]Prospective cohort618/619 0.001)Liu et al., 2006 [135]Prospective cohort122/121BUN 76 mg/dLBUN 76 mg/dLBUN 47 mg/dL = 0.090)Gaudry et al., 2015 [120]Retrospective cohort34/27UO 100 mL/8 h and no response to 50 mg furosemideSCr 5 mg/dL or K 5.5 mEq/L irrespective of UONRNR24%/56% = 0.016)Jun et al., 2014 [121]Retrospective cohortI: 109 = 0.923)Fernandez et al., 2011 [9]Retrospective cohort101/102Within first 3 days after surgeryAfter the third dayNRNR53%/80% 0.001)Ji et al., 2011 [136]Retrospective cohort34/24Within 12 h UO 0.5 mg/kg/h after surgery + 50% increase in baseline of crea and urea12 h after the onset of early criteriaBUN 60.8 mg/dL = 0.020)Carl et al., 2010 [137]Retrospective cohort85/62BUN 100 mg/dLBUN 100 mg/dLBUN 66 mg/dL = NR)Iyem et al., 2009 [138]Retrospective cohort95/90UO 0.5 mL/kg/h after surgery and 50% increase of baseline crea and urea48 h after the onset of early criteriaBUN 54.6 mg/dL = NR, reported as not significant)Shiao et al., 2009 [139]Retrospective cohort51/47RIFLE RiskRIFLE Injury/FailureBUN 68.8 mg/dL = 0.002)Manche et al., 2008 [140]Retrospective cohort56/15HyperkaliemiaUO 0.5 mL/kg/hUrea 14.4 mmol/L 0.001)Andrade et al., 2007 [141]Retrospective cohort18/15On admission24 hUrea 107 mg/dLUrea 153 mg/dL17%/67% = 0.010)Wu et al., 2007 [142]Retrospective cohort54/26BUN 80 mg/dLBUN 80 mg/dLBUN 46.2 mg/dL = 0.040)Piccinni et al., 2005 [143]Retrospective cohort40/40Within 12 h after admission and diagnosis of septic shockClassic RRT indicationsBUN 120 mg/dL = 0.005)Demirkilic et al., 2004 [144]Retrospective cohort27/34UO 100 mL/8 h despite 50 mg furosemideSCr 5 mg/dL or K 5.5 mmol/LNRNR24%/56% = 0.016)Elahi et al., 2004 [145]Retrospective cohort28/36UO 100 mL/8 h = 0.050)Gettings et al. 1999 [146]Retrospective cohort51/49BUN 60 mg/dLBUN 60 mg/dLBUN 43 mg/dL = 0.041) Open in a separate window BUN, Blood urea nitrogen; d, Days; NR, Not reported; em p /em -value, 0.05 statistical significance; RRT, Renal replacement therapy; RCT, Randomized controlled trial; UO, Urine output. a Patients with rhabdomyolysis. In the end, a general problem across all studies that remains is the distinction between beneficial and unnecessary early RRT due to spontaneous renal recovery. Recent data supports this issue by showing a higher autonomous renal recovery rate in the late group and a delayed recovery under early RRT [74,116,125]. Gaudry et al. even showed an autonomous renal recovery of 49% in the late RRT group, with the lowest associated mortality (37.1%). However, patients in the late group without renal recovery revealed the highest mortality (61.8%). This might indicate that the early identification of patients without autonomous recovery, rather than RRT timing, is the real point of interest. Nevertheless, in the single center study by Zarbock et al., the mortality was significantly lower under early RRT [126]. However, the result may have been influenced by a diminished timeframe for autonomous renal recovery due to an Clindamycin Phosphate RRT that Clindamycin Phosphate was applied relatively early in the late RRT group in relation to other studies (Table 4) [74,126]. Hence, current.