TY - JOUR
T1 - Impact of renal-replacement therapy strategies on outcomes for patients with chronic kidney disease
T2 - a secondary analysis of the STARRT-AKI trial
AU - Bagshaw, Sean M.
AU - Neto, Ary Serpa
AU - Smith, Orla
AU - Weir, Matthew
AU - Qiu, Haibo
AU - Du, Bin
AU - Wang, Amanda Y.
AU - Gallagher, Martin P.
AU - Bellomo, Rinaldo
AU - Wald, Ron
AU - on behalf of the STARRT-AKI Investigators
N1 - Funding Information:
Funded by the Canadian Institutes of Health Research and others; STARRT-AKI ClinicalTrials.gov number, NCT02568722. The STARRT-AKI trial was funded by the following sources: Canadian Institutes of Health Research (Open Operating Grant MOP142296 and Project Grant 389635); Canadian Institutes of Health Research in partnership with Baxter (Industry-Partnered Operating Grant IPR 139081); National Health Medical Research Council of Australia (Project Grant 1127121); the Health Research Council of New Zealand (Project Grant 17/204); and the National Institutes of Health Research Health Technology Assessment Program (United Kingdom) (Reference Number: 17/42/74). SMB is supported by a Canada Research Chair in Critical Care Outcomes and Systems Evaluation. AYW is supported by a National Heart Foundation Vanguard Grant. STARRT-AKI steering committee investigators listed (Available at: https://www.ualberta.ca/critical-care/research/current-research/starrtaki/documents.html ). SMB and RW have received unrestricted grants from Baxter to support the STARRT-AKI trial.
Publisher Copyright:
© 2022, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022/12
Y1 - 2022/12
N2 - Purpose: To assess whether pre-existing chronic kidney disease (CKD) modified the relationship between the strategy for renal-replacement theraphy (RRT) initiation and clinical outcomes in the STARRT-AKI trial. Methods: This was a secondary analysis of a multi-national randomized trial. We included patients who had documented pre-existing estimated glomerular filtration rate (eGFR) data prior to hospitalization, and we defined CKD as an eGFR ≤ 59 mL/min/1.73 m2. The primary outcome was all-cause mortality at 90 days. Secondary outcomes included RRT dependence and RRT-free days at 90 days. We used logistic and linear regression and interaction testing to explore the effect of RRT initiation strategy on outcomes by CKD status. Results: We studied 1121 patients who had pre-hospital measures of kidney function. Of these, 432 patients (38.5%) had CKD. The median (IQR) baseline serum creatinine was 130 (114–160) and 76 (64–90) µmol/L for those with and without CKD, respectively. Patients with CKD were older and more likely to have cardiovascular comorbidities and diabetes mellitus. Patients with CKD had higher 90-day mortality (47% vs. 40%, p < 0.001) compared to those without CKD, though this was not significant after covariate adjustment (adjusted odds ratio [aOR], 1.05; 95% CI, 0.79–1.41). Patients with CKD were more likely to remain RRT dependent at 90 days (14% vs. 8%; aOR, 1.89; 95% CI, 1.05–3.43). CKD status did not modify the effect of RRT initiation strategy on 90-day mortality. Among patients with CKD, allocation to the accelerated strategy conferred more than threefold greater odds of RRT dependence at 90 days (aOR 3.18; 95% CI, 1.41–7.91) compared with the standard strategy, whereas RRT initiation strategy had no effect on this outcome among those without CKD (aOR 0.71; 95% CI, 0.34–1.47, p value for interaction, 0.009). Conclusion: In this secondary analysis of the STARRT-AKI trial, an accelerated strategy of RRT initiation conferred a higher risk of 90-day RRT dependence among patients with pre-existing CKD; however, no effect was observed in the absence of CKD.
AB - Purpose: To assess whether pre-existing chronic kidney disease (CKD) modified the relationship between the strategy for renal-replacement theraphy (RRT) initiation and clinical outcomes in the STARRT-AKI trial. Methods: This was a secondary analysis of a multi-national randomized trial. We included patients who had documented pre-existing estimated glomerular filtration rate (eGFR) data prior to hospitalization, and we defined CKD as an eGFR ≤ 59 mL/min/1.73 m2. The primary outcome was all-cause mortality at 90 days. Secondary outcomes included RRT dependence and RRT-free days at 90 days. We used logistic and linear regression and interaction testing to explore the effect of RRT initiation strategy on outcomes by CKD status. Results: We studied 1121 patients who had pre-hospital measures of kidney function. Of these, 432 patients (38.5%) had CKD. The median (IQR) baseline serum creatinine was 130 (114–160) and 76 (64–90) µmol/L for those with and without CKD, respectively. Patients with CKD were older and more likely to have cardiovascular comorbidities and diabetes mellitus. Patients with CKD had higher 90-day mortality (47% vs. 40%, p < 0.001) compared to those without CKD, though this was not significant after covariate adjustment (adjusted odds ratio [aOR], 1.05; 95% CI, 0.79–1.41). Patients with CKD were more likely to remain RRT dependent at 90 days (14% vs. 8%; aOR, 1.89; 95% CI, 1.05–3.43). CKD status did not modify the effect of RRT initiation strategy on 90-day mortality. Among patients with CKD, allocation to the accelerated strategy conferred more than threefold greater odds of RRT dependence at 90 days (aOR 3.18; 95% CI, 1.41–7.91) compared with the standard strategy, whereas RRT initiation strategy had no effect on this outcome among those without CKD (aOR 0.71; 95% CI, 0.34–1.47, p value for interaction, 0.009). Conclusion: In this secondary analysis of the STARRT-AKI trial, an accelerated strategy of RRT initiation conferred a higher risk of 90-day RRT dependence among patients with pre-existing CKD; however, no effect was observed in the absence of CKD.
KW - Acute kidney injury
KW - Dialysis
KW - Mortality
KW - Recovery
KW - Renal-replacement therapy
UR - https://www.scopus.com/pages/publications/85141515299
U2 - 10.1007/s00134-022-06912-w
DO - 10.1007/s00134-022-06912-w
M3 - Article
C2 - 36331570
AN - SCOPUS:85141515299
SN - 0342-4642
VL - 48
SP - 1736
EP - 1750
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 12
ER -
