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,

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,

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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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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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http://hdl.handle.net/10453/176670