Regional Practice Variation and Outcomes in the Standard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Trial: A Post Hoc Secondary Analysis.
Vaara, ST
Serpa Neto, A
Bellomo, R
Adhikari, NKJ
Dreyfuss, D
Gallagher, M
Gaudry, S
Hoste, E
Joannidis, M
Pettilä, V
Wang, AY
Kashani, K
Wald, R
Bagshaw, SM
Ostermann, M
STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Investigators,
- Publisher:
- Wolters Kluwer
- Publication Type:
- Journal Article
- Citation:
- Crit Care Explor, 2024, 6, (2), pp. e1053
- Issue Date:
- 2024-02
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Full metadata record
Field | Value | Language |
---|---|---|
dc.contributor.author | Vaara, ST | |
dc.contributor.author | Serpa Neto, A | |
dc.contributor.author | Bellomo, R | |
dc.contributor.author | Adhikari, NKJ | |
dc.contributor.author | Dreyfuss, D | |
dc.contributor.author | Gallagher, M | |
dc.contributor.author | Gaudry, S | |
dc.contributor.author | Hoste, E | |
dc.contributor.author | Joannidis, M | |
dc.contributor.author | Pettilä, V | |
dc.contributor.author | Wang, AY | |
dc.contributor.author | Kashani, K | |
dc.contributor.author | Wald, R | |
dc.contributor.author | Bagshaw, SM | |
dc.contributor.author | Ostermann, M | |
dc.contributor.author | STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Investigators, | |
dc.date.accessioned | 2024-08-06T03:11:09Z | |
dc.date.available | 2024-08-06T03:11:09Z | |
dc.date.issued | 2024-02 | |
dc.identifier.citation | Crit Care Explor, 2024, 6, (2), pp. e1053 | |
dc.identifier.issn | 2639-8028 | |
dc.identifier.issn | 2639-8028 | |
dc.identifier.uri | http://hdl.handle.net/10453/180092 | |
dc.description.abstract | OBJECTIVES: Among patients with severe acute kidney injury (AKI) admitted to the ICU in high-income countries, regional practice variations for fluid balance (FB) management, timing, and choice of renal replacement therapy (RRT) modality may be significant. DESIGN: Secondary post hoc analysis of the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial (ClinicalTrials.gov number NCT02568722). SETTING: One hundred-fifty-three ICUs in 13 countries. PATIENTS: Altogether 2693 critically ill patients with AKI, of whom 994 were North American, 1143 European, and 556 from Australia and New Zealand (ANZ). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Total mean FB to a maximum of 14 days was +7199 mL in North America, +5641 mL in Europe, and +2211 mL in ANZ (p < 0.001). The median time to RRT initiation among patients allocated to the standard strategy was longest in Europe compared with North America and ANZ (p < 0.001; p < 0.001). Continuous RRT was the initial RRT modality in 60.8% of patients in North America and 56.8% of patients in Europe, compared with 96.4% of patients in ANZ (p < 0.001). After adjustment for predefined baseline characteristics, compared with North American and European patients, those in ANZ were more likely to survive to ICU (p < 0.001) and hospital discharge (p < 0.001) and to 90 days (for ANZ vs. Europe: risk difference [RD], -11.3%; 95% CI, -17.7% to -4.8%; p < 0.001 and for ANZ vs. North America: RD, -10.3%; 95% CI, -17.5% to -3.1%; p = 0.007). CONCLUSIONS: Among STARRT-AKI trial centers, significant regional practice variation exists regarding FB, timing of initiation of RRT, and initial use of continuous RRT. After adjustment, such practice variation was associated with lower ICU and hospital stay and 90-day mortality among ANZ patients compared with other regions. | |
dc.format | Electronic-eCollection | |
dc.language | eng | |
dc.publisher | Wolters Kluwer | |
dc.relation.ispartof | Crit Care Explor | |
dc.relation.isbasedon | 10.1097/CCE.0000000000001053 | |
dc.rights | info:eu-repo/semantics/openAccess | |
dc.subject.classification | 3202 Clinical sciences | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Acute Kidney Injury | |
dc.subject.mesh | Male | |
dc.subject.mesh | Renal Replacement Therapy | |
dc.subject.mesh | Female | |
dc.subject.mesh | Middle Aged | |
dc.subject.mesh | New Zealand | |
dc.subject.mesh | North America | |
dc.subject.mesh | Aged | |
dc.subject.mesh | Intensive Care Units | |
dc.subject.mesh | Australia | |
dc.subject.mesh | Europe | |
dc.subject.mesh | Critical Illness | |
dc.subject.mesh | Treatment Outcome | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Critical Illness | |
dc.subject.mesh | Treatment Outcome | |
dc.subject.mesh | Renal Replacement Therapy | |
dc.subject.mesh | Aged | |
dc.subject.mesh | Middle Aged | |
dc.subject.mesh | Intensive Care Units | |
dc.subject.mesh | North America | |
dc.subject.mesh | Australia | |
dc.subject.mesh | Europe | |
dc.subject.mesh | New Zealand | |
dc.subject.mesh | Female | |
dc.subject.mesh | Male | |
dc.subject.mesh | Acute Kidney Injury | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Acute Kidney Injury | |
dc.subject.mesh | Male | |
dc.subject.mesh | Renal Replacement Therapy | |
dc.subject.mesh | Female | |
dc.subject.mesh | Middle Aged | |
dc.subject.mesh | New Zealand | |
dc.subject.mesh | North America | |
dc.subject.mesh | Aged | |
dc.subject.mesh | Intensive Care Units | |
dc.subject.mesh | Australia | |
dc.subject.mesh | Europe | |
dc.subject.mesh | Critical Illness | |
dc.subject.mesh | Treatment Outcome | |
dc.title | Regional Practice Variation and Outcomes in the Standard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Trial: A Post Hoc Secondary Analysis. | |
dc.type | Journal Article | |
utslib.citation.volume | 6 | |
utslib.location.activity | United States | |
pubs.organisational-group | University of Technology Sydney | |
pubs.organisational-group | University of Technology Sydney/Faculty of Health | |
utslib.copyright.status | open_access | * |
dc.rights.license | This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ | |
dc.date.updated | 2024-08-06T03:11:05Z | |
pubs.issue | 2 | |
pubs.publication-status | Published online | |
pubs.volume | 6 | |
utslib.citation.issue | 2 |
Abstract:
OBJECTIVES: Among patients with severe acute kidney injury (AKI) admitted to the ICU in high-income countries, regional practice variations for fluid balance (FB) management, timing, and choice of renal replacement therapy (RRT) modality may be significant. DESIGN: Secondary post hoc analysis of the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial (ClinicalTrials.gov number NCT02568722). SETTING: One hundred-fifty-three ICUs in 13 countries. PATIENTS: Altogether 2693 critically ill patients with AKI, of whom 994 were North American, 1143 European, and 556 from Australia and New Zealand (ANZ). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Total mean FB to a maximum of 14 days was +7199 mL in North America, +5641 mL in Europe, and +2211 mL in ANZ (p < 0.001). The median time to RRT initiation among patients allocated to the standard strategy was longest in Europe compared with North America and ANZ (p < 0.001; p < 0.001). Continuous RRT was the initial RRT modality in 60.8% of patients in North America and 56.8% of patients in Europe, compared with 96.4% of patients in ANZ (p < 0.001). After adjustment for predefined baseline characteristics, compared with North American and European patients, those in ANZ were more likely to survive to ICU (p < 0.001) and hospital discharge (p < 0.001) and to 90 days (for ANZ vs. Europe: risk difference [RD], -11.3%; 95% CI, -17.7% to -4.8%; p < 0.001 and for ANZ vs. North America: RD, -10.3%; 95% CI, -17.5% to -3.1%; p = 0.007). CONCLUSIONS: Among STARRT-AKI trial centers, significant regional practice variation exists regarding FB, timing of initiation of RRT, and initial use of continuous RRT. After adjustment, such practice variation was associated with lower ICU and hospital stay and 90-day mortality among ANZ patients compared with other regions.
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