Differential effect on mortality of the timing of initiation of renal replacement therapy according to the criteria used to diagnose acute kidney injury: an IDEAL-ICU substudy.
Intensive care unit
Kidney failure
Renal replacement therapy
Septic shock
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
17 08 2023
17 08 2023
Historique:
received:
01
06
2023
accepted:
05
08
2023
medline:
21
8
2023
pubmed:
18
8
2023
entrez:
17
8
2023
Statut:
epublish
Résumé
This substudy of the randomized IDEAL-ICU trial assessed whether the timing of renal replacement therapy (RRT) initiation has a differential effect on 90-day mortality, according to the criteria used to diagnose acute kidney injury (AKI), in patients with early-stage septic shock. Three groups were considered according to the criterion defining AKI: creatinine elevation only (group 1), reduced urinary output only (group 2), creatinine elevation plus reduced urinary output (group 3). Primary outcome was 90-day all-cause death. Secondary endpoints were RRT-free days, RRT dependence and renal function at discharge. We assessed the interaction between RRT strategy (early vs. delayed) and group, and the association between RRT strategy and mortality in each group by logistic regression. Of 488 patients enrolled, 205 (42%) patients were in group 1, 174 (35%) in group 2, and 100 (20%) in group 3. The effect of RRT initiation strategy on 90-day mortality across groups showed significant heterogeneity (adjusted interaction p = 0.021). Mortality was 58% vs. 42% for early vs. late RRT initiation, respectively, in group 1 (p = 0.028); 57% vs. 67%, respectively, in group 2 (p = 0.18); and 58% vs. 55%, respectively, in group 3 (p = 0.79). There was no significant difference in secondary outcomes. The timing of RRT initiation has a differential impact on outcome according to AKI diagnostic criteria. In patients with elevated creatinine only, early RRT initiation was associated with significantly increased mortality. In patients with reduced urine output only, late RRT initiation was associated with a nonsignificant, 10% absolute increase in mortality.
Sections du résumé
BACKGROUND
This substudy of the randomized IDEAL-ICU trial assessed whether the timing of renal replacement therapy (RRT) initiation has a differential effect on 90-day mortality, according to the criteria used to diagnose acute kidney injury (AKI), in patients with early-stage septic shock.
METHODS
Three groups were considered according to the criterion defining AKI: creatinine elevation only (group 1), reduced urinary output only (group 2), creatinine elevation plus reduced urinary output (group 3). Primary outcome was 90-day all-cause death. Secondary endpoints were RRT-free days, RRT dependence and renal function at discharge. We assessed the interaction between RRT strategy (early vs. delayed) and group, and the association between RRT strategy and mortality in each group by logistic regression.
RESULTS
Of 488 patients enrolled, 205 (42%) patients were in group 1, 174 (35%) in group 2, and 100 (20%) in group 3. The effect of RRT initiation strategy on 90-day mortality across groups showed significant heterogeneity (adjusted interaction p = 0.021). Mortality was 58% vs. 42% for early vs. late RRT initiation, respectively, in group 1 (p = 0.028); 57% vs. 67%, respectively, in group 2 (p = 0.18); and 58% vs. 55%, respectively, in group 3 (p = 0.79). There was no significant difference in secondary outcomes.
CONCLUSION
The timing of RRT initiation has a differential impact on outcome according to AKI diagnostic criteria. In patients with elevated creatinine only, early RRT initiation was associated with significantly increased mortality. In patients with reduced urine output only, late RRT initiation was associated with a nonsignificant, 10% absolute increase in mortality.
Identifiants
pubmed: 37592355
doi: 10.1186/s13054-023-04602-7
pii: 10.1186/s13054-023-04602-7
pmc: PMC10436583
doi:
Substances chimiques
Creatinine
AYI8EX34EU
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
316Subventions
Organisme : Ministère des Affaires Sociales et de la Santé
ID : PHRC 2011/A00519-34
Organisme : Ministère des Affaires Sociales et de la Santé
ID : PHRC 2011/A00519-34
Organisme : Ministère des Affaires Sociales et de la Santé
ID : PHRC 2011/A00519-34
Investigateurs
Raphaël Clere-Jehl
(R)
Romain Hernu
(R)
Florent Montini
(F)
Rémi Bruyère
(R)
Christine Lebert
(C)
Julien Bohé
(J)
Julio Badie
(J)
Jean-Pierre Eraldi
(JP)
Jean-Philippe Rigaud
(JP)
Bruno Levy
(B)
Shidasp Siami
(S)
Guillaume Louis
(G)
Lila Bouadma
(L)
Jean-Michel Constantin
(JM)
Emmanuelle Mercier
(E)
Kada Klouche
(K)
Damien Du Cheyron
(D)
Gaël Piton
(G)
Djillali Annane
(D)
Samir Jaber
(S)
Therry van der Linden
(T)
Gilles Blasco
(G)
Jean-Paul Mira
(JP)
Carole Schwebel
(C)
Loïc Chimot
(L)
Philippe Guiot
(P)
Mai-Anh Nay
(MA)
Ferhat Meziani
(F)
Julie Helms
(J)
Claire Roger
(C)
Benjamin Louart
(B)
Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
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