Initiation of continuous renal replacement therapy versus intermittent hemodialysis in critically ill patients with severe acute kidney injury: a secondary analysis of STARRT-AKI trial.

Wald, Ron; Gaudry, Stephane; da Costa, Bruno R; Adhikari, Neill K J; Bellomo, Rinaldo; Du, Bin; Gallagher, Martin P; Hoste, Eric A; Lamontagne, François; Joannidis, Michael; Liu, Kathleen D; McAuley, Daniel F; McGuinness, Shay P; Nichol, Alistair D; Ostermann, Marlies; Palevsky, Paul M; Qiu, Haibo; Pettilä, Ville; Schneider, Antoine G; Smith, Orla M; Vaara, Suvi T; Weir, Matthew; Dreyfuss, Didier; Bagshaw, Sean M

doi:10.1007/s00134-023-07211-8

Title

Initiation of continuous renal replacement therapy versus intermittent hemodialysis in critically ill patients with severe acute kidney injury: a secondary analysis of STARRT-AKI trial.

Publication Date

2023-11

Author(s)

Wald, Ron

Gaudry, Stephane

da Costa, Bruno R

Adhikari, Neill K J

Bellomo, Rinaldo

Du, Bin

Gallagher, Martin P

Hoste, Eric A

Lamontagne, François

Joannidis, Michael

Liu, Kathleen D

McAuley, Daniel F

McGuinness, Shay P

Nichol, Alistair D

Ostermann, Marlies

Palevsky, Paul M

Qiu, Haibo

Pettilä, Ville

Schneider, Antoine G

Smith, Orla M

Vaara, Suvi T

Weir, Matthew

Dreyfuss, Didier

Bagshaw, Sean M

Subject

Acute kidney injury

Continuous

Intermittent hemodialysis

Modality

Mortality

Randomized trial

Renal-replacement therapy

Type of document

Journal Article

OrcId

0000-0003-4411-8169

#PLACEHOLDER_PARENT_METADATA_VALUE#

DOI

10.1007/s00134-023-07211-8

Abstract

There is controversy regarding the optimal renal-replacement therapy (RRT) modality for critically ill patients with acute kidney injury (AKI). We conducted a secondary analysis of the STandard versus Accelerated Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial to compare outcomes among patients who initiated RRT with either continuous renal replacement therapy (CRRT) or intermittent hemodialysis (IHD). We generated a propensity score for the likelihood of receiving CRRT and used inverse probability of treatment with overlap-weighting to address baseline inter-group differences. The primary outcome was a composite of death or RRT dependence at 90-days after randomization. We identified 1590 trial participants who initially received CRRT and 606 who initially received IHD. The composite outcome of death or RRT dependence at 90-days occurred in 823 (51.8%) patients who commenced CRRT and 329 (54.3%) patients who commenced IHD (unadjusted odds ratio (OR) 0.90; 95% confidence interval (CI) 0.75-1.09). After balancing baseline characteristics with overlap weighting, initial receipt of CRRT was associated with a lower risk of death or RRT dependence at 90-days compared with initial receipt of IHD (OR 0.81; 95% CI 0.66-0.99). This association was predominantly driven by a lower risk of RRT dependence at 90-days (OR 0.61; 95% CI 0.39-0.94). In critically ill patients with severe AKI, initiation of CRRT, as compared to IHD, was associated with a significant reduction in the composite outcome of death or RRT dependence at 90-days.

Link

link

Citation

Intensive Care Medicine 2023-11; 49(11)

Jornal Title

Intensive Care Medicine

ISSN

1432-1238

Austin Health

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