Impact of renal-replacement therapy strategies on outcomes for patients with chronic kidney disease : a secondary analysis of the STARRT-AKI trial
© 2022. Springer-Verlag GmbH Germany, part of Springer Nature..
PURPOSE: To assess whether pre-existing chronic kidney disease (CKD) modified the relationship between the strategy for renal-replacement theraphy (RRT) initiation and clinical outcomes in the STARRT-AKI trial.
METHODS: This was a secondary analysis of a multi-national randomized trial. We included patients who had documented pre-existing estimated glomerular filtration rate (eGFR) data prior to hospitalization, and we defined CKD as an eGFR ≤ 59 mL/min/1.73 m2. The primary outcome was all-cause mortality at 90 days. Secondary outcomes included RRT dependence and RRT-free days at 90 days. We used logistic and linear regression and interaction testing to explore the effect of RRT initiation strategy on outcomes by CKD status.
RESULTS: We studied 1121 patients who had pre-hospital measures of kidney function. Of these, 432 patients (38.5%) had CKD. The median (IQR) baseline serum creatinine was 130 (114-160) and 76 (64-90) µmol/L for those with and without CKD, respectively. Patients with CKD were older and more likely to have cardiovascular comorbidities and diabetes mellitus. Patients with CKD had higher 90-day mortality (47% vs. 40%, p < 0.001) compared to those without CKD, though this was not significant after covariate adjustment (adjusted odds ratio [aOR], 1.05; 95% CI, 0.79-1.41). Patients with CKD were more likely to remain RRT dependent at 90 days (14% vs. 8%; aOR, 1.89; 95% CI, 1.05-3.43). CKD status did not modify the effect of RRT initiation strategy on 90-day mortality. Among patients with CKD, allocation to the accelerated strategy conferred more than threefold greater odds of RRT dependence at 90 days (aOR 3.18; 95% CI, 1.41-7.91) compared with the standard strategy, whereas RRT initiation strategy had no effect on this outcome among those without CKD (aOR 0.71; 95% CI, 0.34-1.47, p value for interaction, 0.009).
CONCLUSION: In this secondary analysis of the STARRT-AKI trial, an accelerated strategy of RRT initiation conferred a higher risk of 90-day RRT dependence among patients with pre-existing CKD; however, no effect was observed in the absence of CKD.
| Errataetall: |
ErratumIn: Intensive Care Med. 2023 Mar;49(3):381-383. - PMID 36757471 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:48 |
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| Enthalten in: |
Intensive care medicine - 48(2022), 12 vom: 04. Dez., Seite 1736-1750 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bagshaw, Sean M [VerfasserIn] |
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AYI8EX34EU |
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Date Completed 06.12.2022 Date Revised 19.06.2023 published: Print-Electronic ErratumIn: Intensive Care Med. 2023 Mar;49(3):381-383. - PMID 36757471 Citation Status MEDLINE |
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| doi: |
10.1007/s00134-022-06912-w |
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| 245 | 1 | 0 | |a Impact of renal-replacement therapy strategies on outcomes for patients with chronic kidney disease |b a secondary analysis of the STARRT-AKI trial |
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| 500 | |a Date Revised 19.06.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ErratumIn: Intensive Care Med. 2023 Mar;49(3):381-383. - PMID 36757471 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022. Springer-Verlag GmbH Germany, part of Springer Nature. | ||
| 520 | |a PURPOSE: To assess whether pre-existing chronic kidney disease (CKD) modified the relationship between the strategy for renal-replacement theraphy (RRT) initiation and clinical outcomes in the STARRT-AKI trial | ||
| 520 | |a METHODS: This was a secondary analysis of a multi-national randomized trial. We included patients who had documented pre-existing estimated glomerular filtration rate (eGFR) data prior to hospitalization, and we defined CKD as an eGFR ≤ 59 mL/min/1.73 m2. The primary outcome was all-cause mortality at 90 days. Secondary outcomes included RRT dependence and RRT-free days at 90 days. We used logistic and linear regression and interaction testing to explore the effect of RRT initiation strategy on outcomes by CKD status | ||
| 520 | |a RESULTS: We studied 1121 patients who had pre-hospital measures of kidney function. Of these, 432 patients (38.5%) had CKD. The median (IQR) baseline serum creatinine was 130 (114-160) and 76 (64-90) µmol/L for those with and without CKD, respectively. Patients with CKD were older and more likely to have cardiovascular comorbidities and diabetes mellitus. Patients with CKD had higher 90-day mortality (47% vs. 40%, p < 0.001) compared to those without CKD, though this was not significant after covariate adjustment (adjusted odds ratio [aOR], 1.05; 95% CI, 0.79-1.41). Patients with CKD were more likely to remain RRT dependent at 90 days (14% vs. 8%; aOR, 1.89; 95% CI, 1.05-3.43). CKD status did not modify the effect of RRT initiation strategy on 90-day mortality. Among patients with CKD, allocation to the accelerated strategy conferred more than threefold greater odds of RRT dependence at 90 days (aOR 3.18; 95% CI, 1.41-7.91) compared with the standard strategy, whereas RRT initiation strategy had no effect on this outcome among those without CKD (aOR 0.71; 95% CI, 0.34-1.47, p value for interaction, 0.009) | ||
| 520 | |a CONCLUSION: In this secondary analysis of the STARRT-AKI trial, an accelerated strategy of RRT initiation conferred a higher risk of 90-day RRT dependence among patients with pre-existing CKD; however, no effect was observed in the absence of CKD | ||
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| 650 | 4 | |a Acute kidney injury | |
| 650 | 4 | |a Dialysis | |
| 650 | 4 | |a Mortality | |
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| 650 | 4 | |a Renal-replacement therapy | |
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