No Survival Advantage With Early Renal-Replacement Therapy in AKI

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Mortality no different for early versus delayed strategy for patients with severe acute kidney injury.
Mortality no different for early versus delayed strategy for patients with severe acute kidney injury.

(HealthDay News) -- For patients with severe acute kidney injury, mortality does not differ with either an early or delayed strategy for renal-replacement therapy initiation, according to a study published online in the New England Journal of Medicine. The research was published to coincide with the annual meeting of the American Thoracic Society, held from May 13 to 18 in San Francisco.

Stéphane Gaudry, MD, from the Hôpital Louis Mourier in Colombes, France, and colleagues from the Artificial Kidney Initiation in Kidney Injury Study Group conducted a multicenter randomized trial in which 620 patients with severe acute kidney injury were randomized to an early or delayed strategy of renal-replacement therapy. Renal-replacement therapy was started immediately after randomization with the early strategy, while with the delayed strategy it was initiated if 1 or more of the following criteria were met: severe hyperkalemia, metabolic acidosis, pulmonary edema, blood urea nitrogen level above 112 mg/dL, or oliguria for more than 72 hours after randomization.

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The researchers observed no significant difference in Kaplan-Meier estimates of mortality at day 60 for the early and delayed strategy groups (48.5 versus 49.7%; P = 0.79). Forty-nine percent of patients in the delayed strategy group did not receive renal-replacement therapy.

"We found no significant difference with regard to mortality between an early and a delayed strategy for the initiation of renal-replacement therapy," the authors write.

[RUN editor's note: "Our study should not be interpreted as suggesting that a 'wait and see' approach is safe for all patients," the authors also write. "Indeed, careful surveillance is mandatory when deciding to delay renal-replacement therapy in patients with severe acute kidney injury so that any complication will be detected and renal-replacement therapy initiated without delay. In our trial, delaying the initiation of therapy allowed many patients to recover from acute kidney injury without embarking on such a treatment course."]

Sources

  1. Gaudry S, Hajage D, Schortgen F, et al. Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit. NEJM. doi: 10.1056/NEJMoa1603017.
  2. Mehta RL. Renal-Replacement Therapy in the Critically Ill — Does Timing Matter? NEJM. doi:10.1056/NEJMe1606125. 
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