ELAIN
Trial question
What is the effect of early initiation of RRT among 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: preexisting CKD; previous RRT; glomerulonephritis; interstitial nephritis; vasculitis; HUS; TTP
Interventions
N=112 early RRT (initiation within 8 hours of diagnosis of stage 2 AKI)
N=119 delayed RRT (initiation within 12 hours of stage 3 AKI)
Primary outcome
Death from all causes at day 90
39.3
54.7
54.7 %
41.0 %
27.4 %
13.7 %
0.0 %
Early renal replacement
therapy
Delayed renal replacement
therapy
Significant
decrease ▼
NNT = 6
Significant decrease in death from all causes at day 90 (39.3% vs. 54.7%; HR 0.66, 95% CI 0.45 to 0.97)
Secondary outcomes
Significant decrease in duration of RRT (9 days vs. 25 days; HR 0.69, 95% CI 0.48 to 1)
Significant decrease in deterioration of renal function at day 90 (38.7% vs. 53.6%; OR 0.55, 95% CI 0.32 to 0.93)
Significant decrease in length of hospital stay (51 days vs. 82 days; HR 0.34, 95% CI 0.22 to 0.52)
Safety outcomes
No significant differences in organ dysfunction, adverse events, RRT-related complications.
Significant differences in interleukin-8 concentration at day 1 (65.7 pg/mL vs. 215.5 pg/mL), IL-6 concentration at day 1 (399.4 pg/mL vs. 989.3 pg/mL).
Conclusion
In critically ill patients with AKI, early RRT was superior to delayed RRT with respect to death from all causes at day 90.
Reference
Alexander Zarbock, John A Kellum, Christoph Schmidt et al. Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury: The ELAIN Randomized Clinical Trial. JAMA. 2016 May 24-31;315(20):2190-9.
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