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.
Wald, R
Gaudry, S
da Costa, BR
Adhikari, NKJ
Bellomo, R
Du, B
Gallagher, MP
Hoste, EA
Lamontagne, F
Joannidis, M
Liu, KD
McAuley, DF
McGuinness, SP
Nichol, AD
Ostermann, M
Palevsky, PM
Qiu, H
Pettilä, V
Schneider, AG
Smith, OM
Vaara, ST
Weir, M
Dreyfuss, D
Bagshaw, SM
STARRT-AKI Investigators,
- Publisher:
- Springer Nature
- Publication Type:
- Journal Article
- Citation:
- Intensive Care Med, 2023, 49, (11), pp. 1305-1316
- Issue Date:
- 2023-11
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s00134-023-07211-8.pdf | Published version | 878.28 kB | Adobe PDF |
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Full metadata record
Field | Value | Language |
---|---|---|
dc.contributor.author | Wald, R | |
dc.contributor.author | Gaudry, S | |
dc.contributor.author | da Costa, BR | |
dc.contributor.author | Adhikari, NKJ | |
dc.contributor.author | Bellomo, R | |
dc.contributor.author | Du, B | |
dc.contributor.author | Gallagher, MP | |
dc.contributor.author | Hoste, EA | |
dc.contributor.author | Lamontagne, F | |
dc.contributor.author | Joannidis, M | |
dc.contributor.author | Liu, KD | |
dc.contributor.author | McAuley, DF | |
dc.contributor.author | McGuinness, SP | |
dc.contributor.author | Nichol, AD | |
dc.contributor.author | Ostermann, M | |
dc.contributor.author | Palevsky, PM | |
dc.contributor.author | Qiu, H | |
dc.contributor.author | Pettilä, V | |
dc.contributor.author | Schneider, AG | |
dc.contributor.author | Smith, OM | |
dc.contributor.author | Vaara, ST | |
dc.contributor.author | Weir, M | |
dc.contributor.author | Dreyfuss, D | |
dc.contributor.author | Bagshaw, SM | |
dc.contributor.author | STARRT-AKI Investigators, | |
dc.date.accessioned | 2024-03-14T00:04:43Z | |
dc.date.available | 2023-08-22 | |
dc.date.available | 2024-03-14T00:04:43Z | |
dc.date.issued | 2023-11 | |
dc.identifier.citation | Intensive Care Med, 2023, 49, (11), pp. 1305-1316 | |
dc.identifier.issn | 0342-4642 | |
dc.identifier.issn | 1432-1238 | |
dc.identifier.uri | http://hdl.handle.net/10453/176670 | |
dc.description.abstract | 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. | |
dc.format | Print-Electronic | |
dc.language | eng | |
dc.publisher | Springer Nature | |
dc.relation.ispartof | Intensive Care Med | |
dc.relation.isbasedon | 10.1007/s00134-023-07211-8 | |
dc.rights | info:eu-repo/semantics/closedAccess | |
dc.subject | 1103 Clinical Sciences, 1117 Public Health and Health Services | |
dc.subject.classification | Emergency & Critical Care Medicine | |
dc.subject.classification | 3202 Clinical sciences | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Acute Kidney Injury | |
dc.subject.mesh | Continuous Renal Replacement Therapy | |
dc.subject.mesh | Critical Illness | |
dc.subject.mesh | Renal Dialysis | |
dc.subject.mesh | Renal Replacement Therapy | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Critical Illness | |
dc.subject.mesh | Renal Replacement Therapy | |
dc.subject.mesh | Renal Dialysis | |
dc.subject.mesh | Acute Kidney Injury | |
dc.subject.mesh | Continuous Renal Replacement Therapy | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Acute Kidney Injury | |
dc.subject.mesh | Continuous Renal Replacement Therapy | |
dc.subject.mesh | Critical Illness | |
dc.subject.mesh | Renal Dialysis | |
dc.subject.mesh | Renal Replacement Therapy | |
dc.title | 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. | |
dc.type | Journal Article | |
utslib.citation.volume | 49 | |
utslib.location.activity | United States | |
utslib.for | 1103 Clinical Sciences | |
utslib.for | 1117 Public Health and Health Services | |
pubs.organisational-group | University of Technology Sydney | |
pubs.organisational-group | University of Technology Sydney/Faculty of Health | |
utslib.copyright.status | closed_access | * |
dc.date.updated | 2024-03-14T00:04:42Z | |
pubs.issue | 11 | |
pubs.publication-status | Published | |
pubs.volume | 49 | |
utslib.citation.issue | 11 |
Abstract:
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.
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