• Ron Wald, Stephane Gaudry, Bruno R da Costa, AdhikariNeill K JNKJDepartment of Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada., Rinaldo Bellomo, Bin Du, Martin P Gallagher, Eric A Hoste, François Lamontagne, Michael Joannidis, Kathleen D Liu, Daniel F McAuley, Shay P McGuinness, Alistair D Nichol, Marlies Ostermann, Paul M Palevsky, Haibo Qiu, Ville Pettilä, Antoine G Schneider, Orla M Smith, Suvi T Vaara, Matthew Weir, Didier Dreyfuss, Sean M Bagshaw, and STARRT-AKI Investigators.
• Division of Nephrology, St. Michael's Hospital, University of Toronto, Li Ka Shing Knowledge Institute, Toronto, ON, Canada. waldr@smh.ca.
• Intensive Care Med. 2023 Nov 1; 49 (11): 130513161305-1316.

BackgroundThere is controversy regarding the optimal renal-replacement therapy (RRT) modality for critically ill patients with acute kidney injury (AKI).MethodsWe 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.ResultsWe 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).ConclusionsIn 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.© 2023. Springer-Verlag GmbH Germany, part of Springer Nature.

14 keywords...

hide…