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Title: Renal outcomes according to renal replacement therapy modality and treatment protocol in the ATN and RENAL trials.
Austin Authors: Naorungroj, Thummaporn ;Neto, Ary Serpa;Wang, Amanda;Gallagher, Martin;Bellomo, Rinaldo 
Affiliation: Department of Renal Medicine, Concord Repatriation General Hospital, Concord West, Australia
Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.. Department of Critical Care, The University of Melbourne, Melbourne, Australia
Concord Clinical School, The University of Sydney, Sydney, Australia
Intensive Care
Department of Intensive Care, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand..
The George Institute for Global Health, University of New South Wales, Sydney, Australia
Department of Nephrology, Liverpool Hospital, Sydney, Australia
Australian and New Zealand Intensive Care Research Centre Monash University, Melbourne, Australia
Department of Critical Care, The University of Melbourne, Melbourne, Australia
Data Analytics Research and Evaluation (DARE) Centre
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
Issue Date: 6-Sep-2022
Date: 2022
Publication information: Critical Care (London, England) 2022; 26(1): 269
Abstract: In critically ill patients with acute kidney injury, renal replacement therapy (RRT) modality and treatment protocols may affect kidney recovery. This study explored whether RRT modality and treatment protocol affected RRT dependence in the 'Randomized Evaluation of Normal versus Augmented Level of RRT' and the 'Acute Renal Failure Trial Network' (ATN) trials. Primary outcome was 28-day RRT dependence. Secondary outcomes included RRT dependence among survivors and in different SOFA-based treatment protocol groups. We used the Fine-Gray competing-risk model sub-distribution hazard ratio (SHR) to assess the primary outcome. Analyses were adjusted for confounders. Of 2542 patients, 2175 (85.5%) received continuous RRT (CRRT) and 367 (14.4%) received intermittent hemodialysis (IHD) as first RRT modality. CRRT-first patients had greater illness severity. After adjustment, there was no between-group difference in 28-day RRT dependence (SHR, 0.96 [95% CI 0.84-1.10]; p = 0.570) or hospital mortality (odds ratio [OR], 1.14 [95% CI 0.86-1.52]; p = 0.361) However, among survivors, CRRT-first was associated with decreased 28-day RRT dependence (OR, 0.54 [95% CI 0.37-0.80]; p = 0.002) and more RRT-free days (common OR: 1.38 [95% CI 1.11-1.71]). Moreover, among CRRT-first patient, the ATN treatment protocol was associated with fewer RRT-free days, greater mortality, and a fourfold increase in RRT dependence at day 28. There was no difference in RRT dependence at day 28 between IHD and CRRT. However, among survivors and after adjustment, both IHD-first and the ATN treatment protocol were strongly associated with greater risk of RRT dependence at 28 days after randomization. Trial registration NCT00221013 registered September 22, 2005, and NCT00076219 registered January 19, 2004.
DOI: 10.1186/s13054-022-04151-5
Journal: Critical Care (London, England)
PubMed URL: 36068554
Type: Journal Article
Subjects: Acute kidney injury
Continuous renal replacement therapy
Dialysis dependence
Intermittent hemodialysis
Appears in Collections:Journal articles

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