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Timing of initiation of renal-replacement therapy in acute kidney injury

(2020) NEW ENGLAND JOURNAL OF MEDICINE. 383(3). p.240-251
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Abstract
Background Acute kidney injury is common in critically ill patients, many of whom receive renal-replacement therapy. However, the most effective timing for the initiation of such therapy remains uncertain. Methods We conducted a multinational, randomized, controlled trial involving critically ill patients with severe acute kidney injury. Patients were randomly assigned to receive an accelerated strategy of renal-replacement therapy (in which therapy was initiated within 12 hours after the patient had met eligibility criteria) or a standard strategy (in which renal-replacement therapy was discouraged unless conventional indications developed or acute kidney injury persisted for >72 hours). The primary outcome was death from any cause at 90 days. Results Of the 3019 patients who had undergone randomization, 2927 (97.0%) were included in the modified intention-to-treat analysis (1465 in the accelerated-strategy group and 1462 in the standard-strategy group). Of these patients, renal-replacement therapy was performed in 1418 (96.8%) in the accelerated-strategy group and in 903 (61.8%) in the standard-strategy group. At 90 days, death had occurred in 643 patients (43.9%) in the accelerated-strategy group and in 639 (43.7%) in the standard-strategy group (relative risk, 1.00; 95% confidence interval [CI], 0.93 to 1.09; P=0.92). Among survivors at 90 days, continued dependence on renal-replacement therapy was confirmed in 85 of 814 patients (10.4%) in the accelerated-strategy group and in 49 of 815 patients (6.0%) in the standard-strategy group (relative risk, 1.74; 95% CI, 1.24 to 2.43). Adverse events occurred in 346 of 1503 patients (23.0%) in the accelerated-strategy group and in 245 of 1489 patients (16.5%) in the standard-strategy group (P<0.001). Conclusions Among critically ill patients with acute kidney injury, an accelerated renal-replacement strategy was not associated with a lower risk of death at 90 days than a standard strategy. (Funded by the Canadian Institutes of Health Research and others; STARRT-AKI ClinicalTrials.gov number, NCT02568722.) The most effective timing for renal-replacement therapy in critically ill patients is unclear. In this randomized trial, patients with acute kidney injury who were assigned to an accelerated strategy did not have a lower risk of death at 90 days than those assigned to a standard strategy.
Keywords
CRITICALLY-ILL PATIENTS, MORTALITY, DIALYSIS, TRIALS

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MLA
Bagshaw, Sean M., et al. “Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury.” NEW ENGLAND JOURNAL OF MEDICINE, vol. 383, no. 3, 2020, pp. 240–51, doi:10.1056/NEJMoa2000741.
APA
Bagshaw, S. M., Wald, R., Adhikari, N. K. J., Bellomo, R., da Costa, B. R., Dreyfuss, D., … Zarbock, A. (2020). Timing of initiation of renal-replacement therapy in acute kidney injury. NEW ENGLAND JOURNAL OF MEDICINE, 383(3), 240–251. https://doi.org/10.1056/NEJMoa2000741
Chicago author-date
Bagshaw, Sean M., Ron Wald, Neill K. J. Adhikari, Rinaldo Bellomo, Bruno R. da Costa, Didier Dreyfuss, Martin P. Gallagher, et al. 2020. “Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury.” NEW ENGLAND JOURNAL OF MEDICINE 383 (3): 240–51. https://doi.org/10.1056/NEJMoa2000741.
Chicago author-date (all authors)
Bagshaw, Sean M., Ron Wald, Neill K. J. Adhikari, Rinaldo Bellomo, Bruno R. da Costa, Didier Dreyfuss, Martin P. Gallagher, Stephane Gaudry, Eric Hoste, Francois Lamontagne, Michael Joannidis, Giovanni Landoni, Kathleen D. Liu, Daniel F. McAuley, Shay P. McGuinness, Javier A. Neyra, Alistair D. Nichol, Marlies Ostermann, Paul M. Palevsky, Ville Pettila, Jean-Pierre Quenot, Haibo Qiu, Bram Rochwerg, Antoine G. Schneider, Orla M. Smith, Fernando Thome, Kevin E. Thorpe, Suvi Vaara, Matthew Weir, Amanda Y. Wang, Paul Young, and Alexander Zarbock. 2020. “Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury.” NEW ENGLAND JOURNAL OF MEDICINE 383 (3): 240–251. doi:10.1056/NEJMoa2000741.
Vancouver
1.
Bagshaw SM, Wald R, Adhikari NKJ, Bellomo R, da Costa BR, Dreyfuss D, et al. Timing of initiation of renal-replacement therapy in acute kidney injury. NEW ENGLAND JOURNAL OF MEDICINE. 2020;383(3):240–51.
IEEE
[1]
S. M. Bagshaw et al., “Timing of initiation of renal-replacement therapy in acute kidney injury,” NEW ENGLAND JOURNAL OF MEDICINE, vol. 383, no. 3, pp. 240–251, 2020.
@article{8674636,
  abstract     = {Background Acute kidney injury is common in critically ill patients, many of whom receive renal-replacement therapy. However, the most effective timing for the initiation of such therapy remains uncertain. Methods We conducted a multinational, randomized, controlled trial involving critically ill patients with severe acute kidney injury. Patients were randomly assigned to receive an accelerated strategy of renal-replacement therapy (in which therapy was initiated within 12 hours after the patient had met eligibility criteria) or a standard strategy (in which renal-replacement therapy was discouraged unless conventional indications developed or acute kidney injury persisted for >72 hours). The primary outcome was death from any cause at 90 days. Results Of the 3019 patients who had undergone randomization, 2927 (97.0%) were included in the modified intention-to-treat analysis (1465 in the accelerated-strategy group and 1462 in the standard-strategy group). Of these patients, renal-replacement therapy was performed in 1418 (96.8%) in the accelerated-strategy group and in 903 (61.8%) in the standard-strategy group. At 90 days, death had occurred in 643 patients (43.9%) in the accelerated-strategy group and in 639 (43.7%) in the standard-strategy group (relative risk, 1.00; 95% confidence interval [CI], 0.93 to 1.09; P=0.92). Among survivors at 90 days, continued dependence on renal-replacement therapy was confirmed in 85 of 814 patients (10.4%) in the accelerated-strategy group and in 49 of 815 patients (6.0%) in the standard-strategy group (relative risk, 1.74; 95% CI, 1.24 to 2.43). Adverse events occurred in 346 of 1503 patients (23.0%) in the accelerated-strategy group and in 245 of 1489 patients (16.5%) in the standard-strategy group (P<0.001). Conclusions Among critically ill patients with acute kidney injury, an accelerated renal-replacement strategy was not associated with a lower risk of death at 90 days than a standard strategy. (Funded by the Canadian Institutes of Health Research and others; STARRT-AKI ClinicalTrials.gov number, NCT02568722.) The most effective timing for renal-replacement therapy in critically ill patients is unclear. In this randomized trial, patients with acute kidney injury who were assigned to an accelerated strategy did not have a lower risk of death at 90 days than those assigned to a standard strategy.},
  author       = {Bagshaw, Sean M. and Wald, Ron and Adhikari, Neill K. J. and Bellomo, Rinaldo and da Costa, Bruno R. and Dreyfuss, Didier and Gallagher, Martin P. and Gaudry, Stephane and Hoste, Eric and Lamontagne, Francois and Joannidis, Michael and Landoni, Giovanni and Liu, Kathleen D. and McAuley, Daniel F. and McGuinness, Shay P. and Neyra, Javier A. and Nichol, Alistair D. and Ostermann, Marlies and Palevsky, Paul M. and Pettila, Ville and Quenot, Jean-Pierre and Qiu, Haibo and Rochwerg, Bram and Schneider, Antoine G. and Smith, Orla M. and Thome, Fernando and Thorpe, Kevin E. and Vaara, Suvi and Weir, Matthew and Wang, Amanda Y. and Young, Paul and Zarbock, Alexander},
  issn         = {0028-4793},
  journal      = {NEW ENGLAND JOURNAL OF MEDICINE},
  keywords     = {CRITICALLY-ILL PATIENTS,MORTALITY,DIALYSIS,TRIALS},
  language     = {eng},
  number       = {3},
  pages        = {240--251},
  title        = {Timing of initiation of renal-replacement therapy in acute kidney injury},
  url          = {http://dx.doi.org/10.1056/NEJMoa2000741},
  volume       = {383},
  year         = {2020},
}

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