TY - JOUR
T1 - Regional Practice Variation and Outcomes in the Standard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Trial
T2 - A Post Hoc Secondary Analysis
AU - Vaara, Suvi T.
AU - Serpa Neto, Ary
AU - Bellomo, Rinaldo
AU - Adhikari, Neill K.J.
AU - Dreyfuss, Didier
AU - Gallagher, Martin
AU - Gaudry, Stephane
AU - Hoste, Eric
AU - Joannidis, Michael
AU - Pettilä, Ville
AU - Wang, Amanda Y.
AU - Kashani, Kianoush
AU - Wald, Ron
AU - Bagshaw, Sean M.
AU - Ostermann, Marlies
AU - STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Investigators
AU - Du, Bin
AU - Lamontagne, François
AU - Liu, Kathleen D.
AU - McAuley, Daniel F.
AU - McGuinness, Shay P.
AU - Nichol, Alistair D.
AU - Palevsky, Paul M.
AU - Qiu, Haibo
AU - Schneider, Antoine G.
AU - Smith, Orla M.
AU - Weir, Matthew
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 - Cross, Rosalba
AU - Cheung, Winston
AU - Wong, Helen
AU - Kol, Mark
AU - Shah, Asim
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 - 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 - Staudinger, Thomas
AU - Tiller, Esther
AU - Schellongowski, Peter
AU - Bojic, Andja
AU - Bracke, Stephanie
AU - De Crop, Luc
AU - Vermeiren, Daisy
AU - Thome, Fernando
AU - Chiella, Bianca
AU - Fendt, Lucia
AU - Antunes, Veronica
AU - Maisonneuve-Rosemont,
AU - Lafrance, Jean Philippe
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 - Langis Francoeur, Charles
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 - Tung Sia, Ying
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 - Gordon Boyd, J.
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 - Singh, Gurmeet
AU - Xu, Song
AU - Wang, Peng
AU - Li, Rui
AU - Yang, Yi
AU - Jackson, David
AU - Young, Paul
AU - Jang, Ryan
AU - Thomas, Emma
AU - Stewart, Richard
AU - Lynch, Matthew
AU - Lynch, Matthew
PY - 2024/2
Y1 - 2024/2
N2 - OBJECTIVES: Among patients with severe acute kidney injury (AKI) admitted to the ICU in high-income countries, regional practice variations for fluid balance (FB) management, timing, and choice of renal replacement therapy (RRT) modality may be significant. DESIGN: Secondary post hoc analysis of the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial (ClinicalTrials.gov number NCT02568722). SETTING: One hundred-fifty-three ICUs in 13 countries. PATIENTS: Altogether 2693 critically ill patients with AKI, of whom 994 were North American, 1143 European, and 556 from Australia and New Zealand (ANZ). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Total mean FB to a maximum of 14 days was +7199 mL in North America, +5641 mL in Europe, and +2211 mL in ANZ (p < 0.001). The median time to RRT initiation among patients allocated to the standard strategy was longest in Europe compared with North America and ANZ (p < 0.001; p < 0.001). Continuous RRT was the initial RRT modality in 60.8% of patients in North America and 56.8% of patients in Europe, compared with 96.4% of patients in ANZ (p < 0.001). After adjustment for predefined baseline characteristics, compared with North American and European patients, those in ANZ were more likely to survive to ICU (p < 0.001) and hospital discharge (p < 0.001) and to 90 days (for ANZ vs. Europe: risk difference [RD], -11.3%; 95% CI, -17.7% to -4.8%; p < 0.001 and for ANZ vs. North America: RD, -10.3%; 95% CI, -17.5% to -3.1%; p = 0.007). CONCLUSIONS: Among STARRT-AKI trial centers, significant regional practice variation exists regarding FB, timing of initiation of RRT, and initial use of continuous RRT. After adjustment, such practice variation was associated with lower ICU and hospital stay and 90-day mortality among ANZ patients compared with other regions.
AB - OBJECTIVES: Among patients with severe acute kidney injury (AKI) admitted to the ICU in high-income countries, regional practice variations for fluid balance (FB) management, timing, and choice of renal replacement therapy (RRT) modality may be significant. DESIGN: Secondary post hoc analysis of the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial (ClinicalTrials.gov number NCT02568722). SETTING: One hundred-fifty-three ICUs in 13 countries. PATIENTS: Altogether 2693 critically ill patients with AKI, of whom 994 were North American, 1143 European, and 556 from Australia and New Zealand (ANZ). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Total mean FB to a maximum of 14 days was +7199 mL in North America, +5641 mL in Europe, and +2211 mL in ANZ (p < 0.001). The median time to RRT initiation among patients allocated to the standard strategy was longest in Europe compared with North America and ANZ (p < 0.001; p < 0.001). Continuous RRT was the initial RRT modality in 60.8% of patients in North America and 56.8% of patients in Europe, compared with 96.4% of patients in ANZ (p < 0.001). After adjustment for predefined baseline characteristics, compared with North American and European patients, those in ANZ were more likely to survive to ICU (p < 0.001) and hospital discharge (p < 0.001) and to 90 days (for ANZ vs. Europe: risk difference [RD], -11.3%; 95% CI, -17.7% to -4.8%; p < 0.001 and for ANZ vs. North America: RD, -10.3%; 95% CI, -17.5% to -3.1%; p = 0.007). CONCLUSIONS: Among STARRT-AKI trial centers, significant regional practice variation exists regarding FB, timing of initiation of RRT, and initial use of continuous RRT. After adjustment, such practice variation was associated with lower ICU and hospital stay and 90-day mortality among ANZ patients compared with other regions.
KW - acute kidney injury
KW - continuous renal replacement therapy
KW - fluid balance
KW - intermittent hemodialysis
KW - outcomes
KW - randomized controlled trial
UR - http://www.scopus.com/inward/record.url?scp=85186472367&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/NHMRC/1127121
U2 - 10.1097/CCE.0000000000001053
DO - 10.1097/CCE.0000000000001053
M3 - Article
AN - SCOPUS:85186472367
SN - 2639-8028
VL - 6
JO - Critical care explorations
JF - Critical care explorations
IS - 2
M1 - E1053
ER -