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Clinical Trial
. 2023 Nov;49(11):1305-1316.
doi: 10.1007/s00134-023-07211-8. Epub 2023 Oct 10.

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

Ron Wald #  1 , Stephane Gaudry #  2   3 , Bruno R da Costa  4 , Neill K J Adhikari  5 , Rinaldo Bellomo  6   7   8   9 , Bin Du  10 , Martin P Gallagher  11 , Eric A Hoste  12 , François Lamontagne  13 , Michael Joannidis  14 , Kathleen D Liu  15 , Daniel F McAuley  16 , Shay P McGuinness  17 , Alistair D Nichol  18   19 , Marlies Ostermann  20 , Paul M Palevsky  21   22 , Haibo Qiu  23 , Ville Pettilä  24 , Antoine G Schneider  25 , Orla M Smith  26 , Suvi T Vaara  27 , Matthew Weir  28 , Didier Dreyfuss #  3   29 , Sean M Bagshaw #  30 ; STARRT-AKI Investigators
Collaborators, Affiliations
Clinical Trial

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

Ron Wald et al. Intensive Care Med. 2023 Nov.

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.

Keywords: Acute kidney injury; Continuous; Intermittent hemodialysis; Modality; Mortality; Randomized trial; Renal-replacement therapy.

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References

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