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.

Autor: Barbar SD; Unité de Réanimation Médicale, Service des Réanimations, Centre Hospitalier Universitaire de Nîmes, Hôpital Caremeau, Place du Prof Robert Debré, 30029, Nîmes, France. saber.barbar@chu-nimes.fr.; Université de Montpellier, Montpellier, France. saber.barbar@chu-nimes.fr., Bourredjem A; CIC 1432, Epidémiologie Clinique, Centre Hospitalier Universitaire Dijon-Bourgogne, BP 1541, Dijon, France., Trusson R; Unité de Réanimation Médicale, Service des Réanimations, Centre Hospitalier Universitaire de Nîmes, Hôpital Caremeau, Place du Prof Robert Debré, 30029, Nîmes, France., Dargent A; Medical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Lyon-Sud, 69437, Lyon, France., Binquet C; CIC 1432, Epidémiologie Clinique, Centre Hospitalier Universitaire Dijon-Bourgogne, BP 1541, Dijon, France., Quenot JP; CIC 1432, Epidémiologie Clinique, Centre Hospitalier Universitaire Dijon-Bourgogne, BP 1541, Dijon, France.; Service de Médecine Intensive Réanimation, CHU Dijon, Dijon, France.; Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, Université de Bourgogne, Dijon, France.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2023 Aug 17; Vol. 27 (1), pp. 316. Date of Electronic Publication: 2023 Aug 17.
DOI: 10.1186/s13054-023-04602-7
Abstrakt: 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.
(© 2023. BioMed Central Ltd., part of Springer Nature.)
Databáze: MEDLINE
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