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Long-Term Clinical Outcomes after Early Initiation of RRT in Critically Ill Patients with AKI.

Authors
  • Meersch, Melanie1
  • Küllmar, Mira1
  • Schmidt, Christoph1
  • Gerss, Joachim2
  • Weinhage, Toni3
  • Margraf, Andreas1
  • Ermert, Thomas1
  • Kellum, John A4
  • Zarbock, Alexander5
  • 1 Department of Anaesthesiology, Intensive Care and Pain Medicine and.
  • 2 Institute of Biostatistics and Clinical Research, University Hospital of Münster, Muenster, Germany. , (Germany)
  • 3 Department of Pediatric Rheumatology and Immunology, University Hospital Münster, Muenster, Germany; and. , (Germany)
  • 4 Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • 5 Department of Anaesthesiology, Intensive Care and Pain Medicine and [email protected]
Type
Published Article
Journal
Journal of the American Society of Nephrology
Publisher
American Society of Nephrology
Publication Date
Mar 01, 2018
Volume
29
Issue
3
Pages
1011–1019
Identifiers
DOI: 10.1681/ASN.2017060694
PMID: 29196304
Source
Medline
Keywords
License
Unknown

Abstract

Whether earlier initiation of RRT in critically ill patients with AKI can improve outcomes remains debated. We examined follow-up data from a large clinical trial to prospectively investigate the long-term outcomes associated with the timing of RRT initiation in such patients. We extended the follow-up of patients in the Early Versus Delayed Initiation of RRT in Critically Ill Patients with AKI (ELAIN) Trial from 90 days to 1 year after randomization for 230 (99.6%) patients. The primary outcome was a composite of major adverse kidney events (persistent renal dysfunction, dialysis dependence, and mortality) at 1 year. Secondary outcomes included inflammatory markers. Overall, 72 of 111 (64.9%) and 106 of 119 (89.1%) patients met the primary outcome in the early (stage 2 AKI) and delayed (stage 3 AKI) initiation groups, respectively (odds ratio [OR] with early initiation, 0.23; 95% confidence interval [95% CI], 0.11 to 0.45; P< 0.001). The early initiation group had a 1-year all-cause mortality rate (56 of 111 [50.2%]) significantly lower than that of the delayed initiation group (83 of 119 [69.8%]; absolute difference, -19.6%; 95% CI, -32.0% to -7.2%; P<0.01). After 1 year, 16 of 55 (29.1%) and 23 of 36 (63.9%) surviving patients in the early and delayed groups, respectively, failed to recover renal function (absolute difference, -34.8%; 95% CI, -54.6% to -15.0%; P=0.001). In conclusion, early initiation of RRT in these critically ill patients with AKI significantly reduced the occurrence of major adverse kidney events, reduced mortality, and enhanced renal recovery at 1 year.

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