ELAIN FOLLOW-UP
Trial question
Is early initiation of RRT superior to late initiation of RRT in critically ill patients with AKI?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
37.0% female
63.0% male
N = 231
231 patients (85 female, 146 male)
Inclusion criteria: critically ill patients with AKI
Key exclusion criteria: pre-existing kidney disease not requiring RRT; previous RRT; acute renal injury caused by post-renal obstruction; pregnancy
Interventions
N=111 early RRT initiation (within 8 hours of diagnosis of stage 2 AKI)
N=119 late initiation (within 12 hours of diagnosis of stage 3 AKI)
Primary outcome
Major adverse kidney events consisting of persistent renal dysfunction, dialysis dependence, and death at 1 year
64.9
89.1
89.1 %
66.8 %
44.5 %
22.3 %
0.0 %
Early renal replacement therapy
initiation
Late
initiation
Significant
decrease ▼
NNT = 4
Significant decrease in major adverse kidney events consisting of persistent renal dysfunction, dialysis dependence, and death at 1 year (64.9% vs. 89.1%; OR 0.23, 95% CI 0.11 to 0.45)
Secondary outcomes
Significant decrease in death from all causes at 1 year (50.2% vs. 69.8%; OR 0.62, 95% CI 0.44 to 0.87)
No significant difference in patients who require RRT at 1 year (7.3% vs. 11.1%; OR 0.62, 95% CI 0.15 to 2.69)
Significant decrease in patients with persistent renal dysfunction at 1 year (29.1% vs. 63.9%; OR 0.23, 95% CI 0.09 to 0.57)
Safety outcomes
No significant differences in death due to refractory septic shock, myocardial dysfunction, stroke, or bleeding.
Significant difference in death due to multiple organ dysfunction syndrome (21.4% vs. 38.6%).
Conclusion
In critically ill patients with AKI, early RRT initiation was superior to late initiation with respect to major adverse kidney events consisting of persistent renal dysfunction, dialysis dependence, and death at 1 year.
Reference
Melanie Meersch, Mira Küllmar, Christoph Schmidt et al. Long-Term Clinical Outcomes after Early Initiation of RRT in Critically Ill Patients with AKI. J Am Soc Nephrol. 2018 Mar;29(3):1011-1019.
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