Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis.
Saber Barbar,Raphaël Clere-Jehl,Abderrahmane Bourredjem,Romain Hernu,Florent Montini,Rémi Bruyère,Christine Lebert,Julien Bohé,Julio Badie,Jean-Pierre Eraldi,Jean-Philippe Rigaud,Bruno Levy,Shidasp Siami,Guillaume Louis,Lila Bouadma,Jean-Michel Constantin,Emmanuelle Mercier,Kada Klouche,Damien du Cheyron,Gaël Piton,Djillali Annane,Samir Jaber,Thierry Van Der Linden,Gilles Blasco,Jean-Paul Mira,Carole Schwebel,Loïc Chimot,Philippe Guiot,Mai-Anh Nay,Ferhat Meziani,Julie Helms,Claire Roger,Benjamin Louart,Remi Trusson,Auguste Dargent,Christine Binquet,Jean-Pierre Quenot +36 more
TLDR
Among patients with septic shock who had severe acute kidney injury, there was no significant difference in overall mortality at 90 days between patients who were assigned to an early strategy for the initiation of renal‐replacement therapy and those who were assign to a delayed strategy.Abstract:
Background
Acute kidney injury is the most frequent complication in patients with septic shock and is an independent risk factor for death. Although renal-replacement therapy is the standard of care for severe acute kidney injury, the ideal time for initiation remains controversial.
Methods
In a multicenter, randomized, controlled trial, we assigned patients with early-stage septic shock who had severe acute kidney injury at the failure stage of the risk, injury, failure, loss, and end-stage kidney disease (RIFLE) classification system but without life-threatening complications related to acute kidney injury to receive renal-replacement therapy either within 12 hours after documentation of failure-stage acute kidney injury (early strategy) or after a delay of 48 hours if renal recovery had not occurred (delayed strategy). The failure stage of the RIFLE classification system is characterized by a serum creatinine level 3 times the baseline level (or ≥4 mg per deciliter with a rapid increase of ≥0.5 mg per deciliter), urine output less than 0.3 ml per kilogram of body weight per hour for 24 hours or longer, or anuria for at least 12 hours. The primary outcome was death at 90 days.
Results
The trial was stopped early for futility after the second planned interim analysis. A total of 488 patients underwent randomization; there were no significant between-group differences in the characteristics at baseline. Among the 477 patients for whom follow-up data at 90 days were available, 58% of the patients in the early-strategy group (138 of 239 patients) and 54% in the delayed-strategy group (128 of 238 patients) had died (P=0.38). In the delayed-strategy group, 38% (93 patients) did not receive renal-replacement therapy. Criteria for emergency renal-replacement therapy were met in 17% of the patients in the delayed-strategy group (41 patients).
Conclusions
Among patients with septic shock who had severe acute kidney injury, there was no significant difference in overall mortality at 90 days between patients who were assigned to an early strategy for the initiation of renal-replacement therapy and those who were assigned to a delayed strategy. (Funded by the French Ministry of Health; IDEAL-ICU ClinicalTrials.gov number, NCT01682590.)read more
Citations
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Journal ArticleDOI
Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021.
Laura Evans,Andrew Rhodes,Waleed Alhazzani,Massimo Antonelli,Craig M. Coopersmith,Craig French,Flávia Ribeiro Machado,Lauralyn McIntyre,Marlies Ostermann,Hallie C. Prescott,Christa Schorr,Steven Q. Simpson,W. Joost Wiersinga,Fayez Alshamsi,Derek C. Angus,Yaseen M. Arabi,Luciano Cesar Pontes Azevedo,Richard Beale,Gregory J. Beilman,Emilie P. Belley-Côté,Lisa Burry,Maurizio Cecconi,John Centofanti,Angel Coz Yataco,Jan De Waele,R. Phillip Dellinger,Kent Doi,Bin Du,Elisa Estenssoro,Ricard Ferrer,Charles D. Gomersall,Carol L. Hodgson,Morten Hylander Møller,Theodore J. Iwashyna,Shevin T. Jacob,Ruth M. Kleinpell,Michael Klompas,Michael Klompas,Younsuck Koh,Anand Kumar,Arthur Kwizera,Suzana Margareth Lobo,Henry Masur,Steven McGloughlin,Sangeeta Mehta,Yatin Mehta,Mervyn Mer,Mark E. Nunnally,Simon Oczkowski,Tiffany M. Osborn,Elizabeth Papathanassoglou,Anders Perner,Michael A. Puskarich,Jason A. Roberts,William D. Schweickert,Maureen A. Seckel,Jonathan E. Sevransky,Charles L. Sprung,Charles L. Sprung,Tobias Welte,Janice L. Zimmerman,Mitchell M. Levy +61 more
TL;DR: The Surviving Sepsis Campaign (SSC) guidelines provide evidence-based recommendations on the recognition and management of sepsis and its complications as discussed by the authors, which are either strong or weak, or in the form of best practice statements.
Journal ArticleDOI
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Laura Evans,Andrew Rhodes,Waleed Alhazzani,Massimo Antonelli,Craig M. Coopersmith,Craig French,Flávia Ribeiro Machado,Lauralyn McIntyre,Marlies Ostermann,Hallie C. Prescott,Christa Schorr,Steven Q. Simpson,W. Joost Wiersinga,Fayez Alshamsi,Derek C. Angus,Yaseen M. Arabi,Luciano Cesar Pontes Azevedo,Richard Beale,Gregory J. Beilman,Emilie P. Belley-Côté,Lisa Burry,Maurizio Cecconi,John Centofanti,Angel Coz Yataco,Jan De Waele,R. Phillip Dellinger,Kent Doi,Bin Du,Elisa Estenssoro,Ricard Ferrer,Charles D. Gomersall,Carol L. Hodgson,Morten Hylander Møller,Theodore J. Iwashyna,Shevin T. Jacob,Ruth M. Kleinpell,Michael Klompas,Younsuck Koh,Anand Kumar,Arthur Kwizera,Suzana Margareth Lobo,Henry Masur,Steven McGloughlin,Sangeeta Mehta,Yatin Mehta,Mervyn Mer,Mark E. Nunnally,Simon Oczkowski,Tiffany M. Osborn,Elizabeth Papathanassoglou,Anders Perner,Michael A. Puskarich,Jason A. Roberts,William D. Schweickert,Maureen A. Seckel,Jonathan E. Sevransky,Charles L. Sprung,Tobias Welte,Janice L. Zimmerman,Mitchell M. Levy +59 more
TL;DR: The Surviving Sepsis Campaign (SSC) guidelines provide evidence-based recommendations on the recognition and management of sepsis and its complications as mentioned in this paper, which are either strong or weak, or in the form of best practice statements.
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Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment.
TL;DR: More mechanistic studies are needed to better understand the convoluted pathophysiology of S-AKI and to translate these findings into potential treatment strategies and add to the promising pharmacologic approaches being developed and tested in clinical trials.
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COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup.
Mitra K. Nadim,Lui G. Forni,Lui G. Forni,Ravindra L. Mehta,Michael J. Connor,Kathleen D. Liu,Marlies Ostermann,Thomas Rimmelé,Alexander Zarbock,Samira Bell,Azra Bihorac,Vincenzo Cantaluppi,Eric Hoste,Faeq Husain-Syed,Michael J. Germain,Stuart L. Goldstein,Shruti Gupta,Michael Joannidis,Kianoush Kashani,Jay L. Koyner,Matthieu Legrand,Nuttha Lumlertgul,Sumit Mohan,Neesh Pannu,Zhiyong Peng,Xose L. Perez-Fernandez,Peter Pickkers,John R. Prowle,Thiago Reis,Nattachai Srisawat,Nattachai Srisawat,Ashita Tolwani,Anitha Vijayan,Gianluca Villa,Li Yang,Claudio Ronco,John A. Kellum +36 more
TL;DR: This Consensus Statement from the Acute Disease Quality Initiative provides recommendations for the diagnosis, prevention and management of COVID-19 AKI and for areas of future research, with the aim of improving understanding of the underlying processes and outcomes for patients with CO VID- 19 AKI.
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Sepsis associated acute kidney injury
Jason T. Poston,Jay L. Koyner +1 more
TL;DR: A growing body of knowledge has illuminated the clinical risk factors, pathobiology, response to treatment, and elements of renal recovery that have advanced the authors' ability to prevent, detect, and treat SA-AKI.
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