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
© 2023. Springer-Verlag GmbH Germany, part of Springer Nature..
BACKGROUND: There is controversy regarding the optimal renal-replacement therapy (RRT) modality for critically ill patients with acute kidney injury (AKI).
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:49 |
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| Enthalten in: |
Intensive care medicine - 49(2023), 11 vom: 10. Nov., Seite 1305-1316 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wald, Ron [VerfasserIn] |
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| Links: |
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| Themen: |
Acute kidney injury |
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| Anmerkungen: |
Date Completed 03.11.2023 Date Revised 11.12.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00134-023-07211-8 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM363087230 |
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| 100 | 1 | |a Wald, Ron |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Initiation of continuous renal replacement therapy versus intermittent hemodialysis in critically ill patients with severe acute kidney injury |b a secondary analysis of STARRT-AKI trial |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 03.11.2023 | ||
| 500 | |a Date Revised 11.12.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023. Springer-Verlag GmbH Germany, part of Springer Nature. | ||
| 520 | |a BACKGROUND: There is controversy regarding the optimal renal-replacement therapy (RRT) modality for critically ill patients with acute kidney injury (AKI) | ||
| 520 | |a METHODS: 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 | ||
| 520 | |a RESULTS: 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) | ||
| 520 | |a CONCLUSIONS: 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 | ||
| 650 | 4 | |a Clinical Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute kidney injury | |
| 650 | 4 | |a Continuous | |
| 650 | 4 | |a Intermittent hemodialysis | |
| 650 | 4 | |a Modality | |
| 650 | 4 | |a Mortality | |
| 650 | 4 | |a Randomized trial | |
| 650 | 4 | |a Renal-replacement therapy | |
| 700 | 1 | |a Gaudry, Stephane |e verfasserin |4 aut | |
| 700 | 1 | |a da Costa, Bruno R |e verfasserin |4 aut | |
| 700 | 1 | |a Adhikari, Neill K J |e verfasserin |4 aut | |
| 700 | 1 | |a Bellomo, Rinaldo |e verfasserin |4 aut | |
| 700 | 1 | |a Du, Bin |e verfasserin |4 aut | |
| 700 | 1 | |a Gallagher, Martin P |e verfasserin |4 aut | |
| 700 | 1 | |a Hoste, Eric A |e verfasserin |4 aut | |
| 700 | 1 | |a Lamontagne, François |e verfasserin |4 aut | |
| 700 | 1 | |a Joannidis, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Liu, Kathleen D |e verfasserin |4 aut | |
| 700 | 1 | |a McAuley, Daniel F |e verfasserin |4 aut | |
| 700 | 1 | |a McGuinness, Shay P |e verfasserin |4 aut | |
| 700 | 1 | |a Nichol, Alistair D |e verfasserin |4 aut | |
| 700 | 1 | |a Ostermann, Marlies |e verfasserin |4 aut | |
| 700 | 1 | |a Palevsky, Paul M |e verfasserin |4 aut | |
| 700 | 1 | |a Qiu, Haibo |e verfasserin |4 aut | |
| 700 | 1 | |a Pettilä, Ville |e verfasserin |4 aut | |
| 700 | 1 | |a Schneider, Antoine G |e verfasserin |4 aut | |
| 700 | 1 | |a Smith, Orla M |e verfasserin |4 aut | |
| 700 | 1 | |a Vaara, Suvi T |e verfasserin |4 aut | |
| 700 | 1 | |a Weir, Matthew |e verfasserin |4 aut | |
| 700 | 1 | |a Dreyfuss, Didier |e verfasserin |4 aut | |
| 700 | 1 | |a Bagshaw, Sean M |e verfasserin |4 aut | |
| 700 | 0 | |a STARRT-AKI Investigators |e verfasserin |4 aut | |
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| 700 | 1 | |a Wald, Ron |e investigator |4 oth | |
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| 700 | 1 | |a Bellomo, Rinaldo |e investigator |4 oth | |
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| 700 | 1 | |a Du, Bin |e investigator |4 oth | |
| 700 | 1 | |a Gallagher, Martin P |e investigator |4 oth | |
| 700 | 1 | |a Gaudry, Stéphane |e investigator |4 oth | |
| 700 | 1 | |a Hoste, Eric A |e investigator |4 oth | |
| 700 | 1 | |a Lamontagne, François |e investigator |4 oth | |
| 700 | 1 | |a Joannidis, Michael |e investigator |4 oth | |
| 700 | 1 | |a Liu, Kathleen D |e investigator |4 oth | |
| 700 | 1 | |a McAuley, Daniel F |e investigator |4 oth | |
| 700 | 1 | |a McGuinness, Shay P |e investigator |4 oth | |
| 700 | 1 | |a Nichol, Alistair D |e investigator |4 oth | |
| 700 | 1 | |a Ostermann, Marlies |e investigator |4 oth | |
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