Differential effect on mortality of the timing of initiation of renal replacement therapy according to the criteria used to diagnose acute kidney injury: an IDEAL-ICU substudy

Critical Care

Research

Christine Binquet¹  Abderrahmane Bourredjem¹  Jean-Pierre Quenot²  Auguste Dargent³  Rémi Trusson⁴  Saber Davide Barbar⁵ 

[1] CIC 1432, Epidémiologie Clinique, Centre Hospitalier Universitaire Dijon-Bourgogne, BP 1541, Dijon, France;CIC 1432, Epidémiologie Clinique, Centre Hospitalier Universitaire Dijon-Bourgogne, BP 1541, Dijon, France;Service de Médecine Intensive Réanimation, CHU Dijon, Dijon, France;Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, Université de Bourgogne, Dijon, France;Medical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Lyon-Sud, 69437, Lyon, France;Unité de Réanimation Médicale, Service des Réanimations, Centre Hospitalier Universitaire de Nîmes, Hôpital Caremeau, Place du Prof Robert Debré, 30029, Nîmes, France;Unité de Réanimation Médicale, Service des Réanimations, Centre Hospitalier Universitaire de Nîmes, Hôpital Caremeau, Place du Prof Robert Debré, 30029, Nîmes, France;Université de Montpellier, Montpellier, France;

关键词: Renal replacement therapy;    Kidney failure;    Intensive care unit;    Septic shock;   

DOI  :  10.1186/s13054-023-04602-7

 received in 2023-06-01, accepted in 2023-08-05,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThis substudy of the randomized IDEAL-ICU trial assessed whether the timing of renal replacement therapy (RRT) initiation has a differential effect on 90-day mortality, according to the criteria used to diagnose acute kidney injury (AKI), in patients with early-stage septic shock.MethodsThree groups were considered according to the criterion defining AKI: creatinine elevation only (group 1), reduced urinary output only (group 2), creatinine elevation plus reduced urinary output (group 3). Primary outcome was 90-day all-cause death. Secondary endpoints were RRT-free days, RRT dependence and renal function at discharge. We assessed the interaction between RRT strategy (early vs. delayed) and group, and the association between RRT strategy and mortality in each group by logistic regression.ResultsOf 488 patients enrolled, 205 (42%) patients were in group 1, 174 (35%) in group 2, and 100 (20%) in group 3. The effect of RRT initiation strategy on 90-day mortality across groups showed significant heterogeneity (adjusted interaction p = 0.021). Mortality was 58% vs. 42% for early vs. late RRT initiation, respectively, in group 1 (p = 0.028); 57% vs. 67%, respectively, in group 2 (p = 0.18); and 58% vs. 55%, respectively, in group 3 (p = 0.79). There was no significant difference in secondary outcomes.ConclusionThe timing of RRT initiation has a differential impact on outcome according to AKI diagnostic criteria. In patients with elevated creatinine only, early RRT initiation was associated with significantly increased mortality. In patients with reduced urine output only, late RRT initiation was associated with a nonsignificant, 10% absolute increase in mortality.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

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Fig. 5