Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/34014
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.
Austin Authors: 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
Affiliation: Division of Nephrology, St. Michael's Hospital, University of Toronto, Li Ka Shing Knowledge Institute, Toronto, ON, Canada.
AP-HP, Hôpital Avicenne, Service de Réanimation Médico-Chirurgicale, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France.;UMR S1155, French National Institute of Health and Medical Research (INSERM), CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.
Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada.
Intensive Care
Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China.
The George Institute for Global Health, University of New South Wales, Kensington, NSW, Australia.
Intensive Care Unit, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium.
Department of Medicine, Université de Sherbrooke, Centre de Recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada.
Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria.
Division of Intensive Care and Nephrology, University of California San Francisco, San Francisco, CA, USA.
The Regional Intensive Care Unit, The Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Royal Victoria Hospital, Belfast, UK.
Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland and Medical Research Institute of New Zealand, Wellington, New Zealand.
Department of Critical Care Medicine, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin, Ireland.;Monash University, Melbourne, Australia.
Department of Critical Care Medicine, King's College London, Guy's & St Thomas Hospital, London, UK.
Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.;Kidney Medicine Section, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Department of Critical Care Medicine, Zhongda Hospital Southeast University, Nanjing, China.
Division of Intensive Care Medicine, Department of Perioperative, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Critical Care Medicine Centre, Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Department of Critical Care, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
Department of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Division of Nephrology, London Health Sciences Centre, London, ON, Canada.
UMR S1155, French National Institute of Health and Medical Research (INSERM), CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.;Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpital Louis Mourier, Assistance Publique, Université de Paris-Cité, Paris, France.
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada.
Issue Date: Nov-2023
Date: 2023
Publication information: Intensive Care Medicine 2023-11; 49(11)
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.
URI: https://ahro.austin.org.au/austinjspui/handle/1/34014
DOI: 10.1007/s00134-023-07211-8
ORCID: 0000-0003-4411-8169
Journal: Intensive Care Medicine
PubMed URL: 37815560
ISSN: 1432-1238
Type: Journal Article
Subjects: Acute kidney injury
Continuous
Intermittent hemodialysis
Modality
Mortality
Randomized trial
Renal-replacement therapy
Appears in Collections:Journal articles

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