STARRT-AKI (secondary analysis)
Trial question
What is the role of initiation of continuous RRT in critically ill patients with severe AKI?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
32.0% female
68.0% male
N = 2196
2196 patients (697 female, 1499 male).
Inclusion criteria: critically ill patients with severe AKI.
Key exclusion criteria: sustained low-efficiency daily dialysis as initial RRT modality.
Interventions
N=1590 continuous RRT (continuous dialysis).
N=606 intermittent hemodialysis (intermittent dialysis).
Primary outcome
Death or renal replacement therapy dependence at day 90
51.8%
54.3%
54.3 %
40.7 %
27.1 %
13.6 %
0.0 %
Continuous renal replacement
therapy
Intermittent
hemodialysis
Significant
decrease ▼
NNT = 40
Significant decrease in death or RRT dependence at day 90 (51.8% vs. 54.3%; OR 0.81, 95% CI 0.66 to 0.99).
Secondary outcomes
No significant difference in death at day 90 (47.3% vs. 46%; OR 0.9, 95% CI 0.74 to 1.11).
Significant decrease in RRT dependence at day 90 (8.4% vs. 15.2%; OR 0.61, 95% CI 0.39 to 0.94).
No significant difference in ICU length of stay (12 days vs. 17 days; MD -16.8, 95% CI -34.3 to 0.7).
Conclusion
In critically ill patients with severe AKI, continuous RRT was superior to intermittent hemodialysis with respect to death or RRT dependence at day 90.
Reference
Ron Wald, Stephane Gaudry, Bruno R da Costa et al. Initiation of continuous renal replacement therapy versus intermittent hemodialysis in critically ill patients with severe acute kidney injury: a secondary analysis of STARRT-AKI trial. Intensive Care Med. 2023 Nov;49(11):1305-1316.
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