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Abstract: TH-PO040

Delay in Renal Replacement Therapy Initiation in Critically Ill Patients With AKI: A Secondary Analysis of the STARRT-AKI Trial

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Jeong, Rachel, Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
  • Harvey, Andrea K., Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  • Kirkham, Brian, Applied Health Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
  • Bagshaw, Sean M., Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
  • Wald, Ron, Division of Nephrology, St. Michael's Hospital and the University of Toronto, Toronto, Alberta, Canada

Group or Team Name

  • The STARRT-AKI Investigators
Background

The STARRT-AKI trial demonstrated that earlier initiation of renal-replacement therapy (RRT) does not lead to improved outcomes as compared to a strategy of watchful waiting until a conventional indication arises. However, in patients with persistent acute kidney injury (AKI), the safety of prolonged delay in RRT initiation is unclear. We hypothesized that protracted delays in RRT initiation would be associated with excess mortality. Our objective was to determine the association between relative delay to RRT initiation and outcomes among patients randomized to the standard-strategy in STARRT-AKI.

Methods

We conducted a post-hoc secondary analysis of the standard-strategy group in STARRT-AKI. The exposure was time from randomization to RRT initiation, in quartiles. The primary outcome was all-cause mortality at 90 days after randomization. The association between time to RRT initiation and the outcomes were described as adjusted odds ratios (aOR) or adjusted mean differences (aMD), as appropriate.

Results

There were 1462 patients in the standard-strategy group, of whom 903 (62%) received RRT. Median time (IQR) to RRT initiation was 12.1 (8.3-13.8), 24.5 (21.8-26.5), 46.8 (35.2-52.1), and 96.1 (76.7-139.2) hours across quartiles 1 through 4, respectively. Compared to patients in quartile 1, longer delay to RRT initiation was associated with lower 90-day mortality in quartiles 3 and 4 (aOR [95% CI] 0.52 [0.35-0.77] and 0.63 [0.42-0.94], respectively). There were no significant differences in RRT dependence, number of RRT-free or hospitalization-free days at 90 days. Patients in quartile 4 had longer durations of ICU and hospital stay (aMD [95% CI] 8.26 [5.77-10.74] and 12.42 [7.59-17.25] days, respectively), relative to quartile 1.

Conclusion

Among patients with persistent AKI, delay in RRT initiation was not associated with excess mortality, however, was associated with longer durations of ICU and hospital stay.

Funding

  • Government Support – Non-U.S.