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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

journal contribution
posted on 2023-10-23, 03:20 authored by R Wald, S Gaudry, BR da Costa, NKJ Adhikari, R Bellomo, B Du, MP Gallagher, EA Hoste, F Lamontagne, M Joannidis, KD Liu, DF McAuley, SP McGuinness, AD Nichol, M Ostermann, PM Palevsky, H Qiu, V Pettilä, AG Schneider, OM Smith, ST Vaara, M Weir, D Dreyfuss, SM Bagshaw, GM Eastwood, L Peck, H Young, P Kruger, G Laurie, E Saylor, J Meyer, E Venz, K Wetzig, C French, F McGain, J Mulder, G Fennessy, S Koottayi, S Bates, M Towns, R Morgan, A Tippett, A Udy, C Mason, E Licari, D Gantner, J McClure, A Nichol, P McCracken, J Board, E Martin, S Vallance, M Young, C Vladic, S McGloughlin, D Gattas, H Buhr, J Coles, D Hutch, J Wun, L Cole, C Whitehead, J Lowrey, K Masters, R Gresham, V Campbell, D Gutierrez, J Brailsford, L Forbes, L Murray, T Maguire, M NiChonghaile, Neil OrfordNeil Orford, A Bone, T Elderkin, T Salerno
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.

History

Journal

Intensive Care Medicine

Pagination

1-12

Location

United States

ISSN

0342-4642

eISSN

1432-1238

Language

eng

Publisher

Springer