Intermittent or Continuous Renal-Replacement Therapy in Acute Kidney Injury.
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Gaudry Stéphane, Boubaya Marouane, Louis Guillaume, Chaïbi Khalil, de Montmollin Etienne, Bohé Julien, Desgrouas Maxime, Devautour Clément, Joseph Adrien, Mégarbane Bruno, Camus Christophe, Bailly Pierre, Lambour Alexis, Arrestier Romain, Jaber Samir, Robine Adrien, Chudeau Nicolas, Chevrel Guillaume, La Combe Béatrice, Nicolas Jonathan, Argaud Laurent, Bureau Côme, Kimmoun Antoine, Zucman Noémie, Ricard Jean-Damien, Thiery Guillaume, Faguer Stanislas, Jozwiak Mathieu, Ferrand Nathan, Chousterman Benjamin, Marzouk Mehdi, Cadiet Julien, Combes Alain, Mari Arnaud, Contou Damien, Amathieu Roland, Da Silva Daniel, Gandonnière Charlotte Salmon, Rodie-Talbere Pierre-André, Durand-Zaleski Isabelle, Rossignol Patrick, Quenot Jean-Pierre, Biard Lucie, Bloch Coralie, Dreyfuss Didier, ICRAKI Trial Group
Аннотация
METHODS: In this multicenter, open-label, noninferiority trial, we randomly assigned critically ill adults with acute kidney injury who had indications for renal-replacement therapy to undergo intermittent hemodialysis or continuous renal-replacement therapy as the initial treatment. The primary outcome was a major adverse kidney event - defined as death, dependence on renal-replacement therapy, or a serum creatinine concentration more than 25% above the baseline value - by day 90.
RESULTS: The trial was stopped early after sequential interim analyses showed a sustained signal of higher mortality with intermittent hemodialysis than with continuous renal-replacement therapy. A total of 554 patients underwent randomization, with 272 patients assigned to undergo intermittent hemodialysis and 282 to undergo continuous renal-replacement therapy; 535 patients (260 in the intermittent group and 275 in the continuous group) were included in the intention-to-treat population. A major adverse kidney event occurred by day 90 in 203 patients (78.1%) in the intermittent group and in 197 patients (71.6%) in the continuous group (adjusted absolute risk difference, 6.28 percentage points; 95% confidence interval [CI], -1.22 to 13.79). Death by day 90 occurred in 164 patients (63.1%) and in 147 patients (53.5%), respectively. Kaplan-Meier mortality estimates at day 90 were 63.3% and 53.6% (hazard ratio, 1.30; 95% CI, 1.04 to 1.63). The most common complication potentially related to acute kidney injury or renal-replacement therapy was hypotension, which occurred in 179 patients (68.8%) in the intermittent group and in 183 patients (66.5%) in the continuous group.
CONCLUSIONS: Among critically ill patients with acute kidney injury who had indications for renal-replacement therapy, intermittent hemodialysis as the initial treatment approach was not shown to be noninferior to continuous renal-replacement therapy with respect to major adverse kidney events by day 90 and was associated with higher mortality. (Funded by the French Ministry of Health; ICRAKI ClinicalTrials.gov number, NCT06032884.).