• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Chronic Disease

Postponing renal replacement therapy may result in poor clinical outcomes in patients with severe acute kidney injury 

byNeel MistryandTeddy Guo
June 25, 2021
in Chronic Disease, Nephrology
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

1. The median number of RRT-free days was 12 days (IQR 0-25) in the delayed strategy and 10 days (IQR 0-24) in the more-delayed strategy.

2. Hazard ratio for mortality at day 60 was 1.65 in the more-delayed strategy.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Uncertainty exists regarding the duration for which renal replacement therapy (RRT) can be postponed without inflicting harm to patients with severe acute kidney injury (AKI). While some studies show that delaying RRT in critically ill patients with no severe complications is safe, the extent to which this is true remains unclear. This randomized controlled trial aimed to assess whether a more-delayed initiation strategy (in which RRT is postponed until noticeable hyperkalemia, metabolic acidosis, pulmonary oedema, or blood urea nitrogen > 140 mg/dL) would result in more RRT-free days, compared with a delayed strategy (in which RRT is initiated after randomization). The primary outcome was number of RRT-free days between randomization to day 28, while key secondary outcomes included vital status at day 28 and 60, the percentage of patients receiving RRT at least once, and the number of RRT sessions between randomization and day 28. According to results, the primary outcome of RRT-free days was greater in the delayed strategy compared to the more-delayed strategy. This study was limited by the definition of “delayed” and “more-delayed” treatment with investigators using arbitrary clinical parameters to initiate RRT. Furthermore, the study does not allow for a longitudinal follow-up of patients to assess their quality-of-life with respect to both groups. Nonetheless, this trial provides valuable insight about the limit to which RRT can be safely postponed in critically ill patients with severe AKI.

Click to read the study in The Lancet

Relevant Reading: Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury

In-depth [randomized controlled trial]: Between May 7, 2018, and Oct 11, 2019, 5336 patients were assessed for eligibility from 39 intensive care units in France. Included patients were ≥ 18 years old and hospitalized in the ICU with acute kidney injury (monitored until they had oliguria for > 72 h or a blood urea nitrogen concentration > 112 mg/dL). Those with immediate RRT indication, severe chronic renal failure, recent cardiac arrest, and ongoing pregnancy were excluded. Altogether, 278 patients (137 in the delayed strategy and 141 in the more-delayed strategy) were included in the intention-to-treat (ITT) population.

RELATED REPORTS

Oral tacrolimus noninferior to intravenous cyclophosphamide for lupus nephritis

Radiofrequency renal denervation produces long-lasting reductions in blood pressure

2 Minute Medicine Rewind February 28, 2022

The primary outcome of RRT-free days did not differ between the delayed strategy (12 days, interquartile range [IQR] 0-25) and the more-delayed strategy (10 days, IQR 0-24, p=0.93). This was also true for 60-day mortality in both groups (44% of patients in the delayed strategy group died versus 55% in the more-delayed strategy group, p=0.071). However, in a multivariable analysis, the hazard ratio for death and mechanical ventilation at 60 days was significantly higher in the more-delayed strategy group (hazard ratio [HR] 1.65, 95% confidence interval [CI] 1.09-2.50, p=0.018 and HR 3.44, 95% CI 1.52-7.81, p=0.0020, respectively). Secondary outcomes concerning RRT dependence at day 60 and complications related to AKI or RRT were similar between both groups. Overall, findings from this study suggest that in severe AKI patients with oliguria > 72 h or blood urea nitrogen concentration > 112 mg/dL, longer postponing of RRT initiation did not confer additional benefit and was associated with potential harm.

Image: PD

©2021 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Tags: acute kidney failureacute kidney injuryacute kidney injury (AKI)kidney donorkidney transplantnephrologyrenalrenal failurerenal replacement therapyrenal replacement therapy (RRT)
Previous Post

Aprepitant regimen is linked to decreased chemotherapy-induced nausea and vomiting in women

Next Post

#VisualAbstract: Protection from SARS-CoV-2 re-infection may be diminished among elderly individuals

RelatedReports

Being overweight and obese associated with increased incidence of chronic kidney disease
Nephrology

Oral tacrolimus noninferior to intravenous cyclophosphamide for lupus nephritis

April 27, 2022
Tenofovir disoprovil fumarate HIV prophylaxis linked with minimal kidney impact
Cardiology

Radiofrequency renal denervation produces long-lasting reductions in blood pressure

April 20, 2022
Ticagrelor reversal agent provides immediate and sustained effect
Weekly Rewinds

2 Minute Medicine Rewind February 28, 2022

February 28, 2022
Chronic Disease

Balanced-multi-electrolyte-solution does not reduce risk of death among intensive care patients

January 25, 2022
Next Post
#VisualAbstract: Protection from SARS-CoV-2 re-infection may be diminished among elderly individuals

#VisualAbstract: Protection from SARS-CoV-2 re-infection may be diminished among elderly individuals

Edema index predicts cardiorespiratory fitness in patients with HFrEF and type 2 diabetes mellitus

#VisualAbstract: Combined anti-PD-1 and anti-CTLA-4 blockade improves survival among patients with BRAF-mutated melanoma and elevated LDH

#VisualAbstract: Combined anti-PD-1 and anti-CTLA-4 blockade improves survival among patients with BRAF-mutated melanoma and elevated LDH

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

Get 2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Long-acting cabotegravir significantly decreases incidence of HIV compared to daily oral tenofovir
  • Oral methylprednisolone may reduce risk of progressive renal failure in patients with IgA nephropathy: TESTING Trial
  • #VisualAbstract: Adjuvant capecitabine improves long-term survival in early breast cancer
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.