Meersch M, et al. - This prospective investigation involved evaluation of follow-up data from a large clinical trial, to determine the long-term outcomes associated with the timing of RRT initiation in critically ill patients with AKI. In this patient population, the reported consequences of early initiation of RRT included significantly reduced major adverse kidney events, reduced mortality, and enhanced renal recovery at 1 year.

Methods

• After randomization for 230 (99.6%) patients, researchers extended the follow-up of patients in the Early Versus Delayed Initiation of RRT in Critically Ill Patients with AKI (ELAIN) Trial from 90 days to 1 year.
• A composite of major adverse kidney events (persistent renal dysfunction, dialysis dependence, and mortality) at 1 year was the primary outcome and inflammatory markers were included as secondary outcomes.

Results

• Data showed that a total of 72 of 111 (64.9%) and 106 of 119 (89.1%) patients met the primary outcome in the early (stage 2 AKI) and delayed (stage 3 AKI) initiation groups, respectively (odds ratio [OR] with early initiation, 0.23; 95% confidence interval [95% CI], 0.11 to 0.45; P<0.001).
• Researchers found that 1-year all-cause mortality rate of early initiation group (56 of 111 [50.2%]) was significantly lower than that of the delayed initiation group (83 of 119 [69.8%]; absolute difference, -19.6%; 95% CI, -32.0% to -7.2%; P<0.01).
• They also noted that after 1 year, 16 of 55 (29.1%) and 23 of 36 (63.9%) surviving patients in the early and delayed groups, respectively, failed to recover renal function (absolute difference, -34.8%; 95% CI, -54.6% to -15.0%; P=0.001).