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Comparison of standard and accelerated initiation of renal replacement therapy in acute kidney injury.
- Source :
-
Kidney international [Kidney Int] 2015 Oct; Vol. 88 (4), pp. 897-904. Date of Electronic Publication: 2015 Jul 08. - Publication Year :
- 2015
-
Abstract
- In patients with severe acute kidney injury (AKI) but no urgent indication for renal replacement therapy (RRT), the optimal time to initiate RRT remains controversial. While starting RRT preemptively may have benefits, this may expose patients to unnecessary RRT. To study this, we conducted a 12-center open-label pilot trial of critically ill adults with volume replete severe AKI. Patients were randomized to accelerated (12 h or less from eligibility) or standard RRT initiation. Outcomes were adherence to protocol-defined time windows for RRT initiation (primary), proportion of eligible patients enrolled, follow-up to 90 days, and safety in 101 fully eligible patients (57 with sepsis) with a mean age of 63 years. Median serum creatinine and urine output at enrollment were 268 micromoles/l and 356 ml per 24 h, respectively. In the accelerated arm, all patients commenced RRT and 45/48 did so within 12 h from eligibility (median 7.4 h). In the standard arm, 33 patients started RRT at a median of 31.6 h from eligibility, of which 19 did not receive RRT (6 died and 13 recovered kidney function). Clinical outcomes were available for all patients at 90 days following enrollment, with mortality 38% in the accelerated and 37% in the standard arm. Two surviving patients, both randomized to standard RRT initiation, were still RRT dependent at day 90. No safety signal was evident in either arm. Our findings can inform the design of a large-scale effectiveness randomized control trial.
- Subjects :
- Acute Kidney Injury diagnosis
Acute Kidney Injury mortality
Acute Kidney Injury physiopathology
Aged
Canada
Critical Illness
Feasibility Studies
Female
Hospital Mortality
Humans
Length of Stay
Male
Middle Aged
Pilot Projects
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
Acute Kidney Injury therapy
Kidney physiopathology
Renal Replacement Therapy adverse effects
Renal Replacement Therapy mortality
Time-to-Treatment
Watchful Waiting
Subjects
Details
- Language :
- English
- ISSN :
- 1523-1755
- Volume :
- 88
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Kidney international
- Publication Type :
- Academic Journal
- Accession number :
- 26154928
- Full Text :
- https://doi.org/10.1038/ki.2015.184