• Saber Davide Barbar, Abderrahmane Bourredjem, Rémi Trusson, Auguste Dargent, Christine Binquet, QuenotJean-PierreJPCIC 1432, Epidémiologie Clinique, Centre Hospitalier Universitaire Dijon-Bourgogne, BP 1541, Dijon, France.Service de Médecine Intensive Réanimation, CHU Dijon, Dijon, France.Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLip, and IDEAL-ICU Study.
• Unité de Réanimation Médicale, Service des Réanimations, Centre Hospitalier Universitaire de Nîmes, Hôpital Caremeau, Place du Prof Robert Debré, 30029, Nîmes, France. saber.barbar@chu-nimes.fr.
• Crit Care. 2023 Aug 17; 27 (1): 316316.

BackgroundThis substudy of the randomized IDEAL-ICU trial assessed whether the timing of renal replacement therapy (RRT) initiation has a differential effect on 90-day mortality, according to the criteria used to diagnose acute kidney injury (AKI), in patients with early-stage septic shock.MethodsThree groups were considered according to the criterion defining AKI: creatinine elevation only (group 1), reduced urinary output only (group 2), creatinine elevation plus reduced urinary output (group 3). Primary outcome was 90-day all-cause death. Secondary endpoints were RRT-free days, RRT dependence and renal function at discharge. We assessed the interaction between RRT strategy (early vs. delayed) and group, and the association between RRT strategy and mortality in each group by logistic regression.ResultsOf 488 patients enrolled, 205 (42%) patients were in group 1, 174 (35%) in group 2, and 100 (20%) in group 3. The effect of RRT initiation strategy on 90-day mortality across groups showed significant heterogeneity (adjusted interaction p = 0.021). Mortality was 58% vs. 42% for early vs. late RRT initiation, respectively, in group 1 (p = 0.028); 57% vs. 67%, respectively, in group 2 (p = 0.18); and 58% vs. 55%, respectively, in group 3 (p = 0.79). There was no significant difference in secondary outcomes.ConclusionThe timing of RRT initiation has a differential impact on outcome according to AKI diagnostic criteria. In patients with elevated creatinine only, early RRT initiation was associated with significantly increased mortality. In patients with reduced urine output only, late RRT initiation was associated with a nonsignificant, 10% absolute increase in mortality.© 2023. BioMed Central Ltd., part of Springer Nature.

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