JGH open : an open access journal of gastroenterology and hepatology · 2025
Early Versus Late Dialysis in Cirrhosis Patients and Septic Shock (ELDICS Study): A Randomized Controlled Trial (NCT02937961).
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Maiwall Rakhi, Pasupuleti Samba Siva Rao, Agarwal Prashant, Thomas Sherin, Tevethia Harsh Vardhan, Mathur Rajendra Prasad, Sarin Shiv Kumar
Аннотация
BACKGROUND AND AIM: Critically ill cirrhotics (CIC) pose a management challenge due to severe metabolic and renal impairment. The ideal timing of initiation of dialysis in acute kidney injury (AKI) in CIC is not known. We aimed to compare the safety and efficacy of early (ED) versus late (LD) initiation of sustained low-efficiency dialysis (SLED) in CIC.
METHODS: CIC were randomized to ED (SLED initiated within 6-12 h) or the LD (where SLED was performed when the patient met absolute criteria) group.
RESULTS: Fifty CIC (aged 45.2 ± 10 years), 90% males, 87% alcohol-related, 72% with pneumonia admitted to liver ICU were randomized to ED or LD group. Baseline lactate (mg/dL) (2.7 ± 1.8 vs. 3.3 ± 2.1) and SOFA scores (12.9 ± 2.1 vs. 13.7 ± 4.0) were comparable. Median time to dialysis (in hours) was 7 (IQR 6-8) in ED and 24 (18-48) in LD group. Mortality at 28 days (56% vs. 76%; p = 0.14) was similar. A significantly lower incidence of intradialytic hypotension (IDH) (12% vs. 48%; p = 0.005), and better urea reduction (75% vs. 41%, p = 0.019), reversal of shock (60% vs. 16%; p = 0.001), renal functions (68% vs. 12%; p < 0.001), and lower early deaths at Day 7 were noted in the ED (20% vs. 52%; p = 0.038).
CONCLUSIONS: Timely initiation of dialysis could avert the development or progression of metabolic complications, decrease the incidence of IDH and early deaths in CIC. A higher frequency of recovery of renal functions and reduced AKI-related mortality could be achieved by timely dialysis in CICs. Trial Registration: NCT02937961.
METHODS: CIC were randomized to ED (SLED initiated within 6-12 h) or the LD (where SLED was performed when the patient met absolute criteria) group.
RESULTS: Fifty CIC (aged 45.2 ± 10 years), 90% males, 87% alcohol-related, 72% with pneumonia admitted to liver ICU were randomized to ED or LD group. Baseline lactate (mg/dL) (2.7 ± 1.8 vs. 3.3 ± 2.1) and SOFA scores (12.9 ± 2.1 vs. 13.7 ± 4.0) were comparable. Median time to dialysis (in hours) was 7 (IQR 6-8) in ED and 24 (18-48) in LD group. Mortality at 28 days (56% vs. 76%; p = 0.14) was similar. A significantly lower incidence of intradialytic hypotension (IDH) (12% vs. 48%; p = 0.005), and better urea reduction (75% vs. 41%, p = 0.019), reversal of shock (60% vs. 16%; p = 0.001), renal functions (68% vs. 12%; p < 0.001), and lower early deaths at Day 7 were noted in the ED (20% vs. 52%; p = 0.038).
CONCLUSIONS: Timely initiation of dialysis could avert the development or progression of metabolic complications, decrease the incidence of IDH and early deaths in CIC. A higher frequency of recovery of renal functions and reduced AKI-related mortality could be achieved by timely dialysis in CICs. Trial Registration: NCT02937961.