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10.10.2023 | Original

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

verfasst von: Ron Wald, Stephane Gaudry, Bruno R. da Costa, Neill K. J. Adhikari, Rinaldo Bellomo, Bin Du, Martin P. Gallagher, Eric A. Hoste, François Lamontagne, Michael Joannidis, Kathleen D. Liu, Daniel F. McAuley, Shay P. McGuinness, Alistair D. Nichol, Marlies Ostermann, Paul M. Palevsky, Haibo Qiu, Ville Pettilä, Antoine G. Schneider, Orla M. Smith, Suvi T. Vaara, Matthew Weir, Didier Dreyfuss, Sean M. Bagshaw, the STARRT-AKI Investigators

Erschienen in: Intensive Care Medicine | Ausgabe 11/2023

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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.

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Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, Edipidis K, Forni LG, Gomersall CD, Govil D, Honore PM, Joannes-Boyau O, Joannidis M, Korhonen AM, Lavrentieva A, Mehta RL, Palevsky P, Roessler E, Ronco C, Uchino S, Vazquez JA, Vidal Andrade E, Webb S, Kellum JA (2015) Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med 41(8):1411–1423CrossRefPubMed

Nisula S, Kaukonen KM, Vaara ST, Korhonen AM, Poukkanen M, Karlsson S, Haapio M, Inkinen O, Parviainen I, Suojaranta-Ylinen R, Laurila JJ, Tenhunen J, Reinikainen M, Ala-Kokko T, Ruokonen E, Kuitunen A, Pettila V, Group FS (2013) Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study. Intensive Care Med 39(3):420–428CrossRefPubMed

Ostermann M, Bagshaw SM, Lumlertgul N, Wald R (2022) Indications for and Timing of Initiation of KRT. Clin J Am Soc Nephrol. https://doi.org/10.2215/CJN.05450522CrossRefPubMed

Wald R, Beaubien-Souligny W, Chanchlani R, Clark EG, Neyra JA, Ostermann M, Silver SA, Vaara S, Zarbock A, Bagshaw SM (2022) Delivering optimal renal replacement therapy to critically ill patients with acute kidney injury. Intensive Care Med 48(10):1368–1381CrossRefPubMed

Gaudry S, Palevsky PM, Dreyfuss D (2022) Extracorporeal kidney-replacement therapy for acute kidney injury. N Engl J Med 386(10):964–975CrossRefPubMed

Tolwani A (2012) Continuous renal-replacement therapy for acute kidney injury. N Engl J Med 367(26):2505–2514CrossRefPubMed

Ostermann M, Bellomo R, Burdmann EA, Doi K, Endre ZH, Goldstein SL, Kane-Gill SL, Liu KD, Prowle JR, Shaw AD, Srisawat N, Cheung M, Jadoul M, Winkelmayer WC, Kellum JA, Conference P (2020) Controversies in acute kidney injury: conclusions from a Kidney Disease: improving Global Outcomes (KDIGO) Conference. Kidney Int 98(2):294–309CrossRefPubMedPubMedCentral

Group KDIGOAKIGDW (2012) KDIGO clinical practice guidelines for acute kidney injury. Kidney Int 2(1):1–141

Bagshaw SM, Berthiaume LR, Delaney A, Bellomo R (2008) Continuous versus intermittent renal replacement therapy for critically ill patients with acute kidney injury: a meta-analysis. Crit Care Med 36(2):610–617CrossRefPubMed

10.

Nash DM, Przech S, Wald R, O’Reilly D (2017) Systematic review and meta-analysis of renal replacement therapy modalities for acute kidney injury in the intensive care unit. J Crit Care 41:138–144CrossRefPubMed

11.

Ye Z, Wang Y, Ge L, Guyatt GH, Collister D, Alhazzani W, Bagshaw SM, Belley-Cote EP, Fang F, Hou L, Kolb P, Lamontagne F, Oczkowski S, Pyne L, Rabbat C, Scaum M, Najafabadi BT, Tangamornsuksan W, Wald R, Wang Q, Walsh M, Yao L, Zeng L, Algarni AM, Couban RJ, Alexander PE, Rochwerg B (2021) Comparing renal replacement therapy modalities in critically ill patients with acute kidney injury: a systematic review and network meta-analysis. Crit Care Explor 3(5):e0399CrossRefPubMedPubMedCentral

12.

Schneider AG, Bellomo R, Bagshaw SM, Glassford NJ, Lo S, Jun M, Cass A, Gallagher M (2013) Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis. Intensive Care Med 39(6):987–997CrossRefPubMed

13.

Mehta RL, McDonald B, Gabbai FB, Pahl M, Pascual MT, Farkas A, Kaplan RM, Collaborative Group for Treatment of ARFitICU (2001) A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int 60(3):1154–1163CrossRefPubMed

14.

Uehlinger DE, Jakob SM, Ferrari P, Eichelberger M, Huynh-Do U, Marti HP, Mohaupt MG, Vogt B, Rothen HU, Regli B, Takala J, Frey FJ (2005) Comparison of continuous and intermittent renal replacement therapy for acute renal failure. Nephrol Dial Transplant 20(8):1630–1637CrossRefPubMed

15.

Vinsonneau C, Camus C, Combes A, Costa de Beauregard MA, Klouche K, Boulain T, Pallot JL, Chiche JD, Taupin P, Landais P, Dhainaut JF, Hemodiafe Study G (2006) Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial. Lancet 368(9533):379–385CrossRefPubMed

16.

Bell M, Swing GF, Schon S, Ekbom A, Martling CR (2007) Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure. Intensive Care Med 33(5):773–780CrossRefPubMed

17.

Gaudry S, Grolleau F, Barbar S, Martin-Lefevre L, Pons B, Boulet E, Boyer A, Chevrel G, Montini F, Bohe J, Badie J, Rigaud JP, Vinsonneau C, Porcher R, Quenot JP, Dreyfuss D (2022) Continuous renal replacement therapy versus intermittent hemodialysis as first modality for renal replacement therapy in severe acute kidney injury: a secondary analysis of AKIKI and IDEAL-ICU studies. Crit Care 26(1):93CrossRefPubMedPubMedCentral

18.

Wald R, Shariff SZ, Adhikari NK, Bagshaw SM, Burns KE, Friedrich JO, Garg AX, Harel Z, Kitchlu A, Ray JG (2014) The association between renal replacement therapy modality and long-term outcomes among critically ill adults with acute kidney injury: a retrospective cohort study. Crit Care Med 42(4):868–877CrossRefPubMed

19.

Investigators STARRT-AKI, Bagshaw SM, Wald R, Adhikari NKJ, Bellomo R, da Costa BR, Dreyfuss D, Du B, Gallagher MP, Gaudry S, Hoste EA, Lamontagne F, Joannidis M, Landoni G, Liu KD, McAuley DF, McGuinness SP, Neyra JA, Nichol AD, Ostermann M, Palevsky PM, Pettila V, Quenot JP, Qiu H, Rochwerg B, Schneider AG, Smith OM, Thome F, Thorpe KE, Vaara S, Weir M, Wang AY, Young P, Zarbock A (2020) Timing of initiation of renal-replacement therapy in acute kidney injury. N Engl J Med 383(3):240–251CrossRef

20.

Investigators STARRT-AKI (2019) Statistical analysis plan for the Standard versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial. Crit Care Resusc 21(3):162–170

21.

STARRT-AKI Investigators (2019) Standard versus accelerated initiation of renal replacement therapy in acute kidney injury: study protocol for a multi-national, multi-center, randomized controlled trial. Can J Kidney Health Dis 6:2054358119852937

22.

Thomas LE, Li F, Pencina MJ (2020) Overlap weighting: a propensity score method that mimics attributes of a randomized clinical trial. JAMA 323(23):2417–2418CrossRefPubMed

23.

Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, Wood AM, Carpenter JR (2009) Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 338:b2393CrossRefPubMedPubMedCentral

24.

Leyrat C, Seaman SR, White IR, Douglas I, Smeeth L, Kim J, Resche-Rigon M, Carpenter JR, Williamson EJ (2019) Propensity score analysis with partially observed covariates: How should multiple imputation be used? Stat Methods Med Res 28(1):3–19CrossRefPubMed

25.

Coffman DL, Zhou J, Cai X (2020) Comparison of methods for handling covariate missingness in propensity score estimation with a binary exposure. BMC Med Res Methodol 20(1):168CrossRefPubMedPubMedCentral

26.

da Costa BR, Gahl B, Juni P (2014) Tools and techniques–statistics: propensity score techniques. EuroIntervention 10(6):761–767CrossRefPubMed

27.

Ali MS, Prieto-Alhambra D, Lopes LC, Ramos D, Bispo N, Ichihara MY, Pescarini JM, Williamson E, Fiaccone RL, Barreto ML, Smeeth L (2019) Propensity score methods in health technology assessment: principles, extended applications, and recent advances. Front Pharmacol 10:973CrossRefPubMedPubMedCentral

28.

Li F, Thomas LE, Li F (2019) Addressing extreme propensity scores via the overlap weights. Am J Epidemiol 188(1):250–257PubMed

29.

Robins JM, Hernan MA, Brumback B (2000) Marginal structural models and causal inference in epidemiology. Epidemiology 11(5):550–560CrossRefPubMed

30.

Cole SR, Hernan MA (2008) Constructing inverse probability weights for marginal structural models. Am J Epidemiol 168(6):656–664CrossRefPubMedPubMedCentral

31.

Lins RL, Elseviers MM, Van der Niepen P, Hoste E, Malbrain ML, Damas P, Devriendt J, investigators S (2009) Intermittent versus continuous renal replacement therapy for acute kidney injury patients admitted to the intensive care unit: results of a randomized clinical trial. Nephrol Dial Transplant 24(2):512–518CrossRefPubMed

32.

Augustine JJ, Sandy D, Seifert TH, Paganini EP (2004) A randomized controlled trial comparing intermittent with continuous dialysis in patients with ARF. Am J Kidney Dis 44(6):1000–1007CrossRefPubMed

33.

Bonnassieux M, Duclos A, Schneider AG, Schmidt A, Benard S, Cancalon C, Joannes-Boyau O, Ichai C, Constantin JM, Lefrant JY, Kellum JA, Rimmele T, AzuRea G (2018) Renal replacement therapy modality in the ICU and renal recovery at hospital discharge. Crit Care Med 46(2):e102–e110CrossRefPubMed

34.

Naorungroj T, Neto AS, Wang A, Gallagher M, Bellomo R (2022) Renal outcomes according to renal replacement therapy modality and treatment protocol in the ATN and RENAL trials. Crit Care 26(1):269CrossRefPubMedPubMedCentral

35.

Berbece AN, Richardson RM (2006) Sustained low-efficiency dialysis in the ICU: cost, anticoagulation, and solute removal. Kidney Int 70(5):963–968CrossRefPubMed

36.

Schwenger V, Weigand MA, Hoffmann O, Dikow R, Kihm LP, Seckinger J, Miftari N, Schaier M, Hofer S, Haar C, Nawroth PP, Zeier M, Martin E, Morath C (2012) Sustained low efficiency dialysis using a single-pass batch system in acute kidney injury—a randomized interventional trial: the REnal Replacement Therapy Study in Intensive Care Unit PatiEnts. Crit Care 16(4):R140CrossRefPubMedPubMedCentral

37.

Klarenbach S, Manns B, Pannu N, Clement FM, Wiebe N, Tonelli M, Alberta Kidney Disease N (2009) Economic evaluation of continuous renal replacement therapy in acute renal failure. Int J Technol Assess Health Care 25(3):331–338CrossRefPubMed

38.

Manns B, Doig CJ, Lee H, Dean S, Tonelli M, Johnson D, Donaldson C (2003) Cost of acute renal failure requiring dialysis in the intensive care unit: clinical and resource implications of renal recovery. Crit Care Med 31(2):449–455CrossRefPubMed

39.

Srisawat N, Lawsin L, Uchino S, Bellomo R, Kellum JA, Kidney Investigators BEST (2010) Cost of acute renal replacement therapy in the intensive care unit: results from The Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) study. Crit Care 14(2):R46CrossRefPubMedPubMedCentral

40.

Ethgen O, Schneider AG, Bagshaw SM, Bellomo R, Kellum JA (2015) Economics of dialysis dependence following renal replacement therapy for critically ill acute kidney injury patients. Nephrol Dial Transplant 30(1):54–61CrossRefPubMed

41.

Schortgen F, Soubrier N, Delclaux C, Thuong M, Girou E, Brun-Buisson C, Lemaire F, Brochard L (2000) Hemodynamic tolerance of intermittent hemodialysis in critically ill patients: usefulness of practice guidelines. Am J Respir Crit Care Med 162(1):197–202CrossRefPubMed

42.

Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, Machado FR, McIntyre L, Ostermann M, Prescott HC, Schorr C, Simpson S, Wiersinga WJ, Alshamsi F, Angus DC, Arabi Y, Azevedo L, Beale R, Beilman G, Belley-Cote E, Burry L, Cecconi M, Centofanti J, Coz Yataco A, De Waele J, Dellinger RP, Doi K, Du B, Estenssoro E, Ferrer R, Gomersall C, Hodgson C, Moller MH, Iwashyna T, Jacob S, Kleinpell R, Klompas M, Koh Y, Kumar A, Kwizera A, Lobo S, Masur H, McGloughlin S, Mehta S, Mehta Y, Mer M, Nunnally M, Oczkowski S, Osborn T, Papathanassoglou E, Perner A, Puskarich M, Roberts J, Schweickert W, Seckel M, Sevransky J, Sprung CL, Welte T, Zimmerman J, Levy M (2021) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47(11):1181–1247CrossRefPubMedPubMedCentral

43.

Wald R, Bagshaw SM, STARRT-AKI Investigators (2021) Integration of equipoise into eligibility criteria in the STARRT-AKI trial. Am J Respir Crit Care Med 204(2):234–237CrossRefPubMed

Titel: 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
verfasst von: Ron Wald
Stephane Gaudry
Bruno R. da Costa
Neill K. J. Adhikari
Rinaldo Bellomo
Bin Du
Martin P. Gallagher
Eric A. Hoste
François Lamontagne
Michael Joannidis
Kathleen D. Liu
Daniel F. McAuley
Shay P. McGuinness
Alistair D. Nichol
Marlies Ostermann
Paul M. Palevsky
Haibo Qiu
Ville Pettilä
Antoine G. Schneider
Orla M. Smith
Suvi T. Vaara
Matthew Weir
Didier Dreyfuss
Sean M. Bagshaw
the STARRT-AKI Investigators
Publikationsdatum: 10.10.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 11/2023
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-023-07211-8

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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