ArticleCritical care (London, England)2022
Personalization of renal replacement therapy initiation: a secondary analysis of the AKIKI and IDEAL-ICU trials.
Article in Critical care (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Differential effect on mortality of the timing of initiation of renal replacement therapy according to the criteria used to diagnose acute kidney injury: an IDEAL-ICU substudy.Critical care (London, England) · 2023Trial
- Biomarkers and the prediction of acute kidney injury and renal replacement therapy initiation: a dream within a dream.Intensive care medicine · 2026Article
- From Indications to Outcomes: Fluid Overload, Sepsis, and Severity Shaping Contemporary Renal Replacement Therapy in Pediatric Acute Kidney Injury.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2026Article
- Multidisciplinary guidelines on renal replacement therapy in intensive care medicine.Critical care (London, England) · 2026Review
- Timing of initiating renal replacement therapy in acute kidney injury.Journal of intensive medicine · 2025Article
- Dialysis decision in critically ill patients in intensive care unit.Acute and critical care · 2025Article
- Toward Precision in Critical Care Research: Methods for Observational and Interventional Studies.Critical care medicine · 2024Review
- When to start renal replacement therapy in acute kidney injury: What are we waiting for?Journal of intensive medicine · 2024Review
- Personalizing renal replacement therapy initiation in the intensive care unit: a reinforcement learning-based strategy with external validation on the AKIKI randomized controlled trials.Journal of the American Medical Informatics Association : JAMIA · 2024Article
- A clinical model to predict successful renal replacement therapy (RRT) discontinuation in patients with Acute Kidney Injury (AKI).Clinics (Sao Paulo, Brazil) · 2023Article
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Authors and funding
8 authors.
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Abstract
backgroundTrials comparing early and delayed strategies of renal replacement therapy in patients with severe acute kidney injury may have missed differences in survival as a result of mixing together patients at heterogeneous levels of risks. Our aim was to evaluate the heterogeneity of treatment effect on 60-day mortality from an early vs a delayed strategy across levels of risk for renal replacement therapy initiation under a delayed strategy.
methodsWe used data from the AKIKI, and IDEAL-ICU randomized controlled trials to develop a multivariable logistic regression model for renal replacement therapy initiation within 48 h after allocation to a delayed strategy. We then used an interaction with spline terms in a Cox model to estimate treatment effects across the predicted risks of RRT initiation.
resultsWe analyzed data from 1107 patients (619 and 488 in the AKIKI and IDEAL-ICU trial respectively). In the pooled sample, we found evidence for heterogeneous treatment effects (P = 0.023). Patients at an intermediate-high risk of renal replacement therapy initiation within 48 h may have benefited from an early strategy (absolute risk difference, - 14%; 95% confidence interval, - 27% to - 1%). For other patients, we found no evidence of benefit from an early strategy of renal replacement therapy initiation but a trend for harm (absolute risk difference, 8%; 95% confidence interval, - 5% to 21% in patients at intermediate-low risk).
conclusionsWe have identified a clinically sound heterogeneity of treatment effect of an early vs a delayed strategy of renal replacement therapy initiation that may reflect varying degrees of kidney demand-capacity mismatch.
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