STARRT-AKI (secondary analysis, CKD)
Trial question
What is the effect of RRT initiation strategy in patients with and without CKD?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
31.0% female
69.0% male
N = 1121
1121 patients (353 female, 768 male).
Inclusion criteria: patients with documented pre-existing eGFR data prior to hospitalization.
Key exclusion criteria: eGFR < 20 mL/min/1.73 m².
Interventions
N=689 RRT for patients with CKD (eGFR ≤ 59 mL/min/1.73 m²).
N=432 RRT for patients without CKD (eGFR > 59 mL/min/1.73 m²).
Primary outcome
All-cause mortality at day 90
47.2%
39.5%
47.2 %
35.4 %
23.6 %
11.8 %
0.0 %
Renal replacement therapy for patients with chronic kidney
disease
Renal replacement therapy for patients without chronic kidney
disease
No significant
difference ↔
No significant difference in all-cause mortality at day 90 (47.2% vs. 39.5%; aOR 1.05, 95% CI 0.79 to 1.41).
Secondary outcomes
Significant increase in RRT dependence at day 90 (13.7% vs. 7.7%; aOR 1.89, 95% CI 1.05 to 3.43).
No significant difference in RRT-free days at day 90 (39.7 days vs. 47.9 days; MD -3.24, 95% CI -8.3 to 1.82).
No significant difference in death in the hospital (40.6% vs. 35.6%; OR 1.03, 95% CI 0.76 to 1.37).
Safety outcomes
No significant difference in adverse events.
Conclusion
In patients with documented pre-existing eGFR data prior to hospitalization, RRT for patients with CKD was not superior to RRT for patients without CKD with respect to all-cause mortality at day 90.
Reference
Sean M Bagshaw, Ary Serpa Neto, Orla Smith et al. Impact of renal-replacement therapy strategies on outcomes for patients with chronic kidney disease: a secondary analysis of the STARRT-AKI trial. Intensive Care Med. 2022 Dec;48(12):1736-1750.
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