TY - JOUR
T1 - Dialysis Dependence in Standard versus Accelerated Initiation of KRT in AKI
T2 - A Post Hoc Analysis
AU - Mccoy, Ian E.
AU - Liu, Kathleen D.
AU - Ghamarian, Ehsan
AU - Quenot, Jean Pierre
AU - Zarbock, Alex
AU - Bihorac, Azra
AU - Khoo, Benjamin
AU - Gallagher, Martin P.
AU - Du, Bin
AU - Joannidis, Michael
AU - Kashani, Kianoush
AU - Tolwani, Ashita
AU - Bagshaw, Sean M.
AU - Wald, Ron
AU - STandard versus Accelerated initiation of Renal Replacement Therapy in AKI (STARRT-AKI) Investigators
AU - Bellomo, Rinaldo
AU - Eastwood, Glenn M.
AU - Peck, Leah
AU - Young, Helen
AU - Kruger, Peter
AU - Laurie, Gordon
AU - Saylor, Emma
AU - Meyer, Jason
AU - Venz, Ellen
AU - Wetzig, Krista
AU - French, Craig
AU - McGain, Forbes
AU - Mulder, John
AU - Fennessy, Gerard
AU - Koottayi, Sathyajith
AU - Bates, Samantha
AU - Towns, Miriam
AU - Morgan, Rebecca
AU - Tippett, Anna
AU - Udy, Andrew
AU - Mason, Chris
AU - Licari, Elisa
AU - Gantner, Dashiell
AU - McClure, Jason
AU - Nichol, Alistair
AU - McCracken, Phoebe
AU - Board, Jasmin
AU - Martin, Emma
AU - Vallance, Shirley
AU - Young, Meredith
AU - Vladic, Chelsey
AU - McGloughlin, Steve
AU - Gattas, David
AU - Buhr, Heidi
AU - Coles, Jennifer
AU - Hutch, Debra
AU - Wun, James
AU - Cole, Louise
AU - Whitehead, Christina
AU - Lowrey, Julie
AU - Masters, Kristy
AU - Gresham, Rebecca
AU - Campbell, Victoria
AU - Gutierrez, David
AU - Brailsford, Jane
AU - Forbes, Loretta
AU - Murray, Lauren
AU - Maguire, Teena
AU - NiChonghaile, Martina
AU - Orford, Neil
AU - Bone, Allison
AU - Elderkin, Tania
AU - Salerno, Tania
AU - Chimunda, Tim
AU - Fletcher, Jason
AU - Broadfield, Emma
AU - Porwal, Sanjay
AU - Knott, Cameron
AU - Boschert, Catherine
AU - Smith, Julie
AU - Richardson, Angus
AU - Hill, Dianne
AU - Duke, Graeme
AU - Oziemski, Peter
AU - Cegarra, Santiago
AU - Chan, Peter
AU - Welsh, Deborah
AU - Hunter, Stephanie
AU - Roodenburg, Owen
AU - Dyett, John
AU - Kokotsis, Nicos
AU - Moser, Max
AU - Yang, Yang
AU - Padayachee, Laven
AU - Vetro, Joseph
AU - Gangopadhyay, Himangsu
AU - Kaufman, Melissa
AU - Ghosh, Angaj
AU - Said, Simone
AU - Patel, Alpesh
AU - Bihari, Shailesh
AU - Matheson, Elisha
AU - Jin, Xia
AU - Shrestha, Tapaswi
AU - Schwartz, Kate
AU - Gallagher, Martin P.
AU - Cross, Rosalba
AU - Cheung, Winston
AU - Wong, Helen
AU - Kol, Mark
AU - Shah, Asim
AU - Wang, Amanda Y.
AU - Endre, Zoltan
AU - Bradford, Celia
AU - Janin, Pierre
AU - Finfer, Simon
AU - Diel, Naomi
AU - Gatward, Jonathan
AU - Hammond, Naomi
AU - Delaney, Anthony
AU - Bass, Frances
AU - Yarad, Elizabeth
AU - Buscher, Hergen
AU - Reynolds, Claire
AU - Baker, Nerilee
AU - Joannidis, Michael
AU - Bellmann, Romuald
AU - Peer, Andreas
AU - Hasslacher, Julia
AU - Koglberger, Paul
AU - Klein, Sebastian
AU - Zotter, Klemens
AU - Brandtner, Anna
AU - Finkenstedt, Armin
AU - Ditlbacher, Adelheid
AU - Hartig, Frank
AU - Fries, Dietmar
AU - Bachler, Mirjam
AU - Schenk, Bettina
AU - Wagner, Martin
AU - Eller, Philipp
AU - Staudinger, Thomas
AU - Tiller, Esther
AU - Schellongowski, Peter
AU - Bojic, Andja
AU - Hoste, Eric A.
AU - Bracke, Stephanie
AU - De Crop, Luc
AU - Vermeiren, Daisy
AU - Thome, Fernando
AU - Chiella, Bianca
AU - Fendt, Lucia
AU - Antunes, Veronica
AU - Lafrance, Jean Philippe
AU - Lamontagne, François
AU - D'Aragon, Frédérick
AU - St-Arnaud, Charles
AU - Mayette, Michael
AU - Carbonnaeu, Élaine
AU - Marchand, Joannie
AU - Masse, Marie Hélène
AU - Ladouceur, Marilène
AU - Turgeon, Alexis F.
AU - Lauzier, François
AU - Bellemare, David
AU - Francoeur, Charles Langis
AU - LeBlanc, Guillaume
AU - Guilbault, Gabrielle
AU - Grenier, Stéphanie
AU - Cloutier, Eve
AU - Boivin, Annick
AU - Delisle-Thibault, Charles
AU - Giannakouros, Panagiota
AU - Costerousse, Olivier
AU - Cailhier, Jean François
AU - Carrier, François Martin
AU - Ghamraoui, Ali
AU - Lebrasseur, Martine
AU - Benettaib, Fatna
AU - Salamé, Maya
AU - Boumahni, Dounia
AU - Sia, Ying Tung
AU - Naud, Jean François
AU - Roy, Isabelle
AU - Stelfox, Henry T.
AU - Ruddell, Stacey
AU - Manns, Braden J.
AU - Duggan, Shelley
AU - Carney, Dominic
AU - Barchard, Jennifer
AU - Whitlock, Richard P.
AU - Belley-Cote, Emilie
AU - Savija, Nevena
AU - Sabev, Alexandra
AU - Campbell, Troy
AU - Creary, Thais
AU - Devereaux, Kelson
AU - Brodutch, Shira
AU - Rigatto, Claudio
AU - Paunovic, Bojan
AU - Mooney, Owen
AU - Glybina, Anna
AU - Harasemiw, Oksana
AU - Di Nella, Michelle
AU - Harmon, John
AU - Mehta, Navdeep
AU - Lakatos, Louis
AU - Haslam, Nicole
AU - Lellouche, Francois
AU - Simon, Mathieu
AU - Tung, Ying
AU - Lizotte, Patricia
AU - Bourchard, Pierre Alexandre
AU - Rochwerg, Bram
AU - Karachi, Tim
AU - Millen, Tina
AU - Muscedere, John
AU - Maslove, David
AU - Boyd, J. Gordon
AU - Sibley, Stephanie
AU - Drover, John
AU - Hunt, Miranda
AU - Georgescu, Ilinca
AU - Wax, Randy
AU - Lenga, Ilan
AU - Sridhar, Kavita
AU - Steele, Andrew
AU - Fusco, Kelly
AU - Ghate, Taneera
AU - Tolibas, Michael
AU - Robinson, Holly
AU - Weir, Matthew A.
AU - Taneja, Ravi
AU - Ball, Ian M.
AU - Garg, Amit
AU - Campbell, Eileen
AU - Ovsenek, Athena
AU - Bagshaw, Sean M.
AU - van Diepen, Sean
AU - Baig, Nadia
AU - Magder, Sheldon
AU - Yao, Han
AU - Alam, Ahsan
AU - Campisi, Josie
AU - MacIntyre, Erika
AU - Rokosh, Ella
AU - Scherr, Kimberly
AU - Lapinsky, Stephen
AU - Mehta, Sangeeta
AU - Shah, Sumesh
AU - Niven, Daniel J.
AU - Stelfox, Henry T.
AU - Ruddell, Stacey
AU - Russell, Michael
AU - Jim, Kym
AU - Brown, Gillian
N1 - Publisher Copyright:
Copyright © 2025 by the American Society of Nephrology.
PY - 2025/5
Y1 - 2025/5
N2 - Background: The Standard versus Accelerated Initiation of Renal Replacement Therapy in AKI Trial showed that among critically ill patients with AKI, an accelerated KRT initiation strategy resulted in more KRT dependence at 90 days, as compared with a standard strategy. However, it is unclear whether this difference exists among participants who likely would have been treated with KRT in usual practice. Methods: Secondary analysis of the Standard versus Accelerated Initiation of Renal Replacement Therapy in AKI randomized controlled trial, analyzing participants who received more than the median number of days of KRT, which served as a proxy for high probability of requiring KRT under usual practice. Two sensitivity analyses redefined the cohort as (1) those with ≥24 hours of oliguria who received KRT and (2) those who received any KRT. Using the same statistical approach as the original trial, we calculated unadjusted relative risks with 95% confidence intervals (CIs) for the exposure of randomized KRT initiation strategy (accelerated versus standard) on the outcome of KRT dependence at 90 days among survivors. Results: Among the 1184 participants who received ≥6 days of KRT (670 and 514 in the accelerated and standard arms, respectively), baseline characteristics remained balanced between treatment arms. The relative risk of KRT dependence at 90 days was attenuated and nonsignificant: 1.21 (95% CI, 0.84 to 1.78), compared with 1.74 (95% CI, 1.24 to 2.43) in the overall trial. The results were similar in sensitivity analyses. Conclusions: Among patients who likely would have been treated with KRT in usual practice, there was no significant difference in 90-day KRT dependence among survivors between those randomized to the accelerated and standard KRT initiation strategies. These results suggest that the harm of long-term KRT dependence may be largely due to KRT initiation (versus never initiation) rather than earlier initiation.
AB - Background: The Standard versus Accelerated Initiation of Renal Replacement Therapy in AKI Trial showed that among critically ill patients with AKI, an accelerated KRT initiation strategy resulted in more KRT dependence at 90 days, as compared with a standard strategy. However, it is unclear whether this difference exists among participants who likely would have been treated with KRT in usual practice. Methods: Secondary analysis of the Standard versus Accelerated Initiation of Renal Replacement Therapy in AKI randomized controlled trial, analyzing participants who received more than the median number of days of KRT, which served as a proxy for high probability of requiring KRT under usual practice. Two sensitivity analyses redefined the cohort as (1) those with ≥24 hours of oliguria who received KRT and (2) those who received any KRT. Using the same statistical approach as the original trial, we calculated unadjusted relative risks with 95% confidence intervals (CIs) for the exposure of randomized KRT initiation strategy (accelerated versus standard) on the outcome of KRT dependence at 90 days among survivors. Results: Among the 1184 participants who received ≥6 days of KRT (670 and 514 in the accelerated and standard arms, respectively), baseline characteristics remained balanced between treatment arms. The relative risk of KRT dependence at 90 days was attenuated and nonsignificant: 1.21 (95% CI, 0.84 to 1.78), compared with 1.74 (95% CI, 1.24 to 2.43) in the overall trial. The results were similar in sensitivity analyses. Conclusions: Among patients who likely would have been treated with KRT in usual practice, there was no significant difference in 90-day KRT dependence among survivors between those randomized to the accelerated and standard KRT initiation strategies. These results suggest that the harm of long-term KRT dependence may be largely due to KRT initiation (versus never initiation) rather than earlier initiation.
KW - Renal Replacement Therapy
KW - dialysis
KW - patient outcomes
UR - http://www.scopus.com/inward/record.url?scp=105002770674&partnerID=8YFLogxK
U2 - 10.2215/CJN.0000000672
DO - 10.2215/CJN.0000000672
M3 - Article
C2 - 40232884
AN - SCOPUS:105002770674
SN - 1555-9041
VL - 20
SP - 601
EP - 607
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 5
ER -