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
Abstract Background This 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...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-08-01
|
| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-023-04602-7 |
| _version_ | 1797740753845223424 |
|---|---|
| author | Saber Davide Barbar Abderrahmane Bourredjem Rémi Trusson Auguste Dargent Christine Binquet Jean-Pierre Quenot IDEAL-ICU Study |
| author_facet | Saber Davide Barbar Abderrahmane Bourredjem Rémi Trusson Auguste Dargent Christine Binquet Jean-Pierre Quenot IDEAL-ICU Study |
| author_sort | Saber Davide Barbar |
| collection | DOAJ |
| description | Abstract Background This 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. Methods Three 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. Results Of 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. Conclusion The 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. |
| first_indexed | 2024-03-12T14:16:57Z |
| format | Article |
| id | doaj.art-dd622bf6f0b54f118619be523d33359e |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-03-12T14:16:57Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-dd622bf6f0b54f118619be523d33359e2023-08-20T11:12:41ZengBMCCritical Care1364-85352023-08-012711910.1186/s13054-023-04602-7Differential 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 substudySaber Davide Barbar0Abderrahmane Bourredjem1Rémi Trusson2Auguste Dargent3Christine Binquet4Jean-Pierre Quenot5IDEAL-ICU StudyUnité de Réanimation Médicale, Service des Réanimations, Centre Hospitalier Universitaire de Nîmes, Hôpital CaremeauCIC 1432, Epidémiologie Clinique, Centre Hospitalier Universitaire Dijon-BourgogneUnité de Réanimation Médicale, Service des Réanimations, Centre Hospitalier Universitaire de Nîmes, Hôpital CaremeauMedical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Lyon-SudCIC 1432, Epidémiologie Clinique, Centre Hospitalier Universitaire Dijon-BourgogneCIC 1432, Epidémiologie Clinique, Centre Hospitalier Universitaire Dijon-BourgogneAbstract Background This 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. Methods Three 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. Results Of 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. Conclusion The 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.https://doi.org/10.1186/s13054-023-04602-7Renal replacement therapyKidney failureIntensive care unitSeptic shock |
| spellingShingle | Saber Davide Barbar Abderrahmane Bourredjem Rémi Trusson Auguste Dargent Christine Binquet Jean-Pierre Quenot IDEAL-ICU Study 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 Renal replacement therapy Kidney failure Intensive care unit Septic shock |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Renal replacement therapy Kidney failure Intensive care unit Septic shock |
| url | https://doi.org/10.1186/s13054-023-04602-7 |
| work_keys_str_mv | AT saberdavidebarbar differentialeffectonmortalityofthetimingofinitiationofrenalreplacementtherapyaccordingtothecriteriausedtodiagnoseacutekidneyinjuryanidealicusubstudy AT abderrahmanebourredjem differentialeffectonmortalityofthetimingofinitiationofrenalreplacementtherapyaccordingtothecriteriausedtodiagnoseacutekidneyinjuryanidealicusubstudy AT remitrusson differentialeffectonmortalityofthetimingofinitiationofrenalreplacementtherapyaccordingtothecriteriausedtodiagnoseacutekidneyinjuryanidealicusubstudy AT augustedargent differentialeffectonmortalityofthetimingofinitiationofrenalreplacementtherapyaccordingtothecriteriausedtodiagnoseacutekidneyinjuryanidealicusubstudy AT christinebinquet differentialeffectonmortalityofthetimingofinitiationofrenalreplacementtherapyaccordingtothecriteriausedtodiagnoseacutekidneyinjuryanidealicusubstudy AT jeanpierrequenot differentialeffectonmortalityofthetimingofinitiationofrenalreplacementtherapyaccordingtothecriteriausedtodiagnoseacutekidneyinjuryanidealicusubstudy AT idealicustudy differentialeffectonmortalityofthetimingofinitiationofrenalreplacementtherapyaccordingtothecriteriausedtodiagnoseacutekidneyinjuryanidealicusubstudy |