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Early Dialysis Does Not Reduce Mortality in Critically Ill With AKI

WEDNESDAY, July 22, 2020 -- Accelerated initiation of renal-replacement therapy is not associated with a reduced risk for death at 90 days among critically ill patients with acute kidney injury, according to a study published in the July 16 issue of the New England Journal of Medicine.

Sean M. Bagshaw, M.D., from the University of Alberta in Edmonton, Canada, and colleagues randomly assigned critically ill patients with severe acute kidney injury to receive either an accelerated strategy of renal-replacement therapy, involving therapy initiation within 12 hours, or a standard strategy, in which renal-replacement therapy was discouraged unless conventional indications developed or acute kidney injury lasted more than 72 hours (1,465 and 1,462 patients, respectively, in the modified intention-to-treat analysis).

Renal-replacement therapy was performed in 96.8 percent of patients in the accelerated-strategy group and 61.8 percent of patients in the standard-strategy group. The researchers found that death occurred in 43.9 and 43.7 percent of patients in the accelerated-strategy and standard-strategy groups, respectively, at 90 days (relative risk, 1.00; 95 percent confidence interval, 0.93 to 1.09; P = 0.92). Continued dependence on renal-replacement therapy was confirmed in 10.4 and 6.0 percent of patients, respectively, among survivors at 90 days (relative risk, 1.74; 95 percent confidence interval, 1.24 to 2.43).

"This study gives clinicians confidence that, in patients with acute kidney injury where dialysis is appropriate but not urgent, waiting to start dialysis is likely to be safe and may reduce the need for this valuable but invasive treatment," a coauthor said in a statement.

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Posted: July 2020

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