Evidence map›Paper›PMID 26154928›Full record

Trial reportKidney international2015

Comparison of standard and accelerated initiation of renal replacement therapy in acute kidney injury.

Ron Wald, Neill K J Adhikari, Orla M Smith, Matthew A Weir, Karen Pope, Ashley Cohen, Kevin Thorpe, Lauralyn McIntyre, Francois Lamontagne, Mark Soth and 13 more

Abstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Kidney international, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 105 papers, 25 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
105citing papers in PubMed, 25 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

105 citing papers in PubMed, 25 syntheses or guidelines pooled it.

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  5. Timing of kidney replacement therapy initiation for acute kidney injury.The Cochrane database of systematic reviews · 2022
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  16. Timing of renal replacement therapy initiation for acute kidney injury.The Cochrane database of systematic reviews · 2018
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45 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

23 authors.

Ron WaldDivision of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
Neill K J AdhikariDepartment of Critical Care Medicine, Sunnybrook Health Sciences Centre and Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada.
Orla M SmithLi Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada.
Matthew A WeirDivision of Nephrology, London Health Sciences Centre and Western University, London, Ontario, Canada.
Karen PopeApplied Health Research Centre, St Michael's Hospital, Toronto, Ontario, Canada.
Ashley CohenApplied Health Research Centre, St Michael's Hospital, Toronto, Ontario, Canada.
Kevin ThorpeApplied Health Research Centre, St Michael's Hospital, Toronto, Ontario, Canada.
Lauralyn McIntyreDivision of Critical Care Medicine, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada.
Francois LamontagneDivision of Critical Care Medicine, Centre Hospitalier Universite de Sherbrooke, Sherbrooke, Quebec, Canada.
Mark SothDivision of Critical Care Medicine, St Joseph's Healthcare, Hamilton, Ontario, Canada.
Margaret HerridgeDivision of Critical Care, University Health Network, Toronto, Ontario, Canada.
Stephen LapinskyDivision of Critical Care, Mt Sinai Hospital, Toronto, Ontario, Canada.
Edward ClarkDivision of Nephrology, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada.
Amit X GargDivision of Nephrology, London Health Sciences Centre and Western University, London, Ontario, Canada.
Swapnil HiremathDivision of Nephrology, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada.
David KleinLi Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada.
C David MazerLi Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada.
Robert M A RichardsonDivision of Nephrology, University Health Network, Toronto, Ontario, Canada.
M Elizabeth WilcoxDivision of Critical Care Medicine, St Joseph's Healthcare, Hamilton, Ontario, Canada.
Jan O FriedrichLi Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada.
Karen E A BurnsLi Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada.
Sean M BagshawDivision of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Canadian Critical Care Trials Group

Funding

Canadian Institutes of Health Research
6 · The paper itself

Abstract

In patients with severe acute kidney injury (AKI) but no urgent indication for renal replacement therapy (RRT), the optimal time to initiate RRT remains controversial. While starting RRT preemptively may have benefits, this may expose patients to unnecessary RRT. To study this, we conducted a 12-center open-label pilot trial of critically ill adults with volume replete severe AKI. Patients were randomized to accelerated (12 h or less from eligibility) or standard RRT initiation. Outcomes were adherence to protocol-defined time windows for RRT initiation (primary), proportion of eligible patients enrolled, follow-up to 90 days, and safety in 101 fully eligible patients (57 with sepsis) with a mean age of 63 years. Median serum creatinine and urine output at enrollment were 268 micromoles/l and 356 ml per 24 h, respectively. In the accelerated arm, all patients commenced RRT and 45/48 did so within 12 h from eligibility (median 7.4 h). In the standard arm, 33 patients started RRT at a median of 31.6 h from eligibility, of which 19 did not receive RRT (6 died and 13 recovered kidney function). Clinical outcomes were available for all patients at 90 days following enrollment, with mortality 38% in the accelerated and 37% in the standard arm. Two surviving patients, both randomized to standard RRT initiation, were still RRT dependent at day 90. No safety signal was evident in either arm. Our findings can inform the design of a large-scale effectiveness randomized control trial.

Indexed as

Renal Replacement TherapyTime-to-TreatmentWatchful WaitingAcute Kidney InjuryAgedCanadaCritical IllnessFeasibility StudiesFemaleHospital MortalityHumansKidneyLength of StayMaleMiddle AgedPilot Projects

Identifiers

PMID26154928

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.