August 14, 2016

Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit

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 This multicenter randomized trial assigned 620 ICU patients with severe stages 1-3 AKI with either an early dialysis start (at randomization) or late dialysis start (a classic indication to initiate).  The primary outcome was survival at day 60.  There was no survival difference between the groups at day 60; 150 deaths occurred among 311 patients in the early-strategy group (48.5%; 95% confidence interval [CI], 42.6 to 53.8), and 153 deaths occurred among 308 patients in the delayed-strategy group (49.7%, 95% CI, 43.8 to 55.0; P=0.79). 49% of patients in the delayed-strategy group did not receive renal-replacement therapy. Furthermore, the rate of catheter-related bloodstream infections was higher in the early-strategy group and diuresis occurred earlier in the delayed-strategy group.

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