Monday, August 24, 2020

Timing of Renal Replacement Therapy

REBEL CRIT - August 24, 2020 -  By Mark Ramzy
Paper: The STARRT-AKI Investigators. Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury. N Engl J Med. 2020; PMID: 32668114
Clinical Question:
Does initiation of an accelerated or standard renal replacement therapy result in lower risk of death from any cause at 90 days in critically ill patients with acute kidney injury?
Author’s 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.
Our Conclusion:
With this being yet another RCT, the decision to initiate early RRT versus a standard therapy in critically ill patients with acute kidney injury has not shown any mortality benefit at 90 days. Patients in the accelerated arm were more dependent on RRT at 90 days and had more adverse events. Multiple studies have validated these findings and short of acute indications for RRT, medically managing these patients appears to be the best strategy in an effort to delay RRT.