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dc.contributor.authorBagshaw, Sean M-
dc.contributor.authorWald, Ron-
dc.contributor.authorAdhikari, Neill K J-
dc.contributor.authorBellomo, Rinaldo-
dc.contributor.authorda Costa, Bruno R-
dc.contributor.authorDreyfuss, Didier-
dc.contributor.authorDu, Bin-
dc.contributor.authorGallagher, Martin P-
dc.contributor.authorGaudry, Stéphane-
dc.contributor.authorHoste, Eric A-
dc.contributor.authorLamontagne, François-
dc.contributor.authorJoannidis, Michael-
dc.contributor.authorLandoni, Giovanni-
dc.contributor.authorLiu, Kathleen D-
dc.contributor.authorMcAuley, Daniel F-
dc.contributor.authorMcGuinness, Shay P-
dc.contributor.authorNeyra, Javier A-
dc.contributor.authorNichol, Alistair D-
dc.contributor.authorOstermann, Marlies-
dc.contributor.authorPalevsky, Paul M-
dc.contributor.authorPettilä, Ville-
dc.contributor.authorQuenot, Jean-Pierre-
dc.contributor.authorQiu, Haibo-
dc.contributor.authorRochwerg, Bram-
dc.contributor.authorSchneider, Antoine G-
dc.contributor.authorSmith, Orla M-
dc.contributor.authorThomé, Fernando-
dc.contributor.authorThorpe, Kevin E-
dc.contributor.authorVaara, Suvi-
dc.contributor.authorWeir, Matthew-
dc.contributor.authorWang, Amanda Y-
dc.contributor.authorYoung, Paul-
dc.contributor.authorZarbock, Alexander-
dc.identifier.citationThe New England Journal of Medicine 2020; 383(3): 240-251en
dc.description.abstractAcute kidney injury is common in critically ill patients, many of whom receive renal-replacement therapy. However, the most effective timing for the initiation of such therapy remains uncertain. We conducted a multinational, randomized, controlled trial involving critically ill patients with severe acute kidney injury. Patients were randomly assigned to receive an accelerated strategy of renal-replacement therapy (in which therapy was initiated within 12 hours after the patient had met eligibility criteria) or a standard strategy (in which renal-replacement therapy was discouraged unless conventional indications developed or acute kidney injury persisted for >72 hours). The primary outcome was death from any cause at 90 days. Of the 3019 patients who had undergone randomization, 2927 (97.0%) were included in the modified intention-to-treat analysis (1465 in the accelerated-strategy group and 1462 in the standard-strategy group). Of these patients, renal-replacement therapy was performed in 1418 (96.8%) in the accelerated-strategy group and in 903 (61.8%) in the standard-strategy group. At 90 days, death had occurred in 643 patients (43.9%) in the accelerated-strategy group and in 639 (43.7%) in the standard-strategy group (relative risk, 1.00; 95% confidence interval [CI], 0.93 to 1.09; P = 0.92). Among survivors at 90 days, continued dependence on renal-replacement therapy was confirmed in 85 of 814 patients (10.4%) in the accelerated-strategy group and in 49 of 815 patients (6.0%) in the standard-strategy group (relative risk, 1.74; 95% CI, 1.24 to 2.43). Adverse events occurred in 346 of 1503 patients (23.0%) in the accelerated-strategy group and in 245 of 1489 patients (16.5%) in the standard-strategy group (P<0.001). Among critically ill patients with acute kidney injury, an accelerated renal-replacement strategy was not associated with a lower risk of death at 90 days than a standard strategy. (Funded by the Canadian Institutes of Health Research and others; STARRT-AKI number, NCT02568722.).en
dc.titleTiming of Initiation of Renal-Replacement Therapy in Acute Kidney Injury.en
dc.typeJournal Articleen
dc.identifier.journaltitleThe New England Journal of Medicineen
dc.identifier.affiliationDepartment of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmontonen
dc.identifier.affiliationDivision of Nephrology, St. Michael's Hospital and the University of Toronto, Li Ka Shing Knowledge Institute, Department of Medicine, and Applied Health Research Centre, St. Michael's Hospital, the Dalla Lana School of Public Health, the Institute of Health Policy, Management, and Evaluation, University of Toronto, and the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Canadaen
dc.identifier.affiliationDepartment of Medicine, Université de Sherbrooke and Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Sherbrooke, Sherbrooke, Canadaen
dc.identifier.affiliationDivision of Critical Care, Juravinski Hospital, McMaster University, Hamilton, ON, Canadaen
dc.identifier.affiliationDivision of Nephrology, London Health Sciences Centre, London, ON, Canadaen
dc.identifier.affiliationIntensive Careen
dc.identifier.affiliationRoyal Melbourne Hospital, School of Medicine, University of Melbourne, Melbourne, VIC, Australiaen
dc.identifier.affiliationAustralian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australiaen
dc.identifier.affiliationGeorge Institute for Global Health, Concord Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australiaen
dc.identifier.affiliationInstitute of Primary Health Care, University of Bern, Bern, Switzerlanden
dc.identifier.affiliationDepartment of Critical Care Medicine, CHU Vaudois, Lausanne, Switzerlanden
dc.identifier.affiliationHôpital Louis Mourier and Université Léonard de Vinci, INSERM Unité UMR S1155, Sorbonne Université and Université de Paris, Paris, Hôpital Avicenne, Bobigny, and Hôpital Universitaire François Mitterrand, Lipness Team, INSERM Research Center Lipids, Nutrition, Cancer-Unité Mixte de Recherche 1231 and Laboratoire d'Excellence LipSTIC, Centre d'Investigation Clinique-Epidemiologie Clinique, CHU Dijon-Bourgogne, and INSERM Centre d'Investigation Clinique 1432, Université de Bourgogne, Dijon, Franceen
dc.identifier.affiliationDepartment of Critical Care Medicine, Peking Union Medical College Hospital, Beijing, Chinaen
dc.identifier.affiliationDepartment of Critical Care Medicine, Zhongda Hospital Southeast University, Nanjing, Chinaen
dc.identifier.affiliationDepartment of Intensive Care, University of Ghent, Ghent, Belgiumen
dc.identifier.affiliationDivision of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austriaen
dc.identifier.affiliationVita Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milanen
dc.identifier.affiliationDivisions of Nephrology and Critical Care Medicine, University of California, San Francisco, San Franciscoen
dc.identifier.affiliationWellcome-Wolfson Institute for Experimental Medicine, Queen's University, and the Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, United Kingdomen
dc.identifier.affiliationKing's College London, Guy's and St. Thomas' Hospital, London, United Kingdomen
dc.identifier.affiliationCardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Aucklanden
dc.identifier.affiliationMedical Research Institute of New Zealand, New Zealanden
dc.identifier.affiliationIntensive Care Unit, Wellington Regional Hospital and Medical Research Institute of New Zealand, Wellington, New Zealanden
dc.identifier.affiliationDivision of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexingtonen
dc.identifier.affiliationUniversity College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublinen
dc.identifier.affiliationDivision of Nephrology, University of Pittsburgh, and Veterans Affairs Pittsburgh Healthcare System, Pittsburghen
dc.identifier.affiliationDepartment of Intensive Care, University of Helsinki, and Helsinki University Hospital, Helsinki Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazilen
dc.identifier.affiliationDepartment of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germanyen
dc.type.austinJournal Article-
dc.type.austinResearch Support, Non-U.S. Gov't-, Rinaldo
item.openairetypeJournal Article-
item.fulltextNo Fulltext- Care- Analytics Research and Evaluation (DARE) Centre-
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