Time to Renal Replacement Therapy Initiation in Critically Ill Patients With Acute Kidney Injury: A Secondary Analysis of the STARRT-AKI Trial.
In critically ill patients with severe acute kidney injury but no emergency indication, waiting longer to start dialysis was not linked to a higher risk of death at 90 days, though longer delays were associated with more ongoing dialysis dependence.
Background
The STARRT-AKI trial showed that preemptive RRT initiation does not improve outcomes, but the safety of prolonged delays in patients with persistent AKI and no urgent indication remained unclear.
Key findings
Of 1462 patients in the standard-strategy group, 903 (62%) received RRT, with median time to initiation ranging from 12.1 hours (quartile 1) to 96.1 hours (quartile 4). A longer time to initiation appeared protective in crude analysis (quartile 4 vs 1 adjusted odds ratio 0.63, 95% CI 0.42-0.94), but analyses correcting for immortal-time bias showed no association with death. Longer delay had a linear association with RRT dependence at 90 days.
Clinical implications
In critically ill AKI patients without urgent indications, deferring RRT does not appear to increase mortality, supporting a conservative initiation strategy; however, clinicians should weigh a possible signal toward greater dialysis dependence with very prolonged waiting.
Category
Research
Source
Critical Care Medicine
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