Acute Kidney Injury: AKIKI (Artificial Kidney Initiation in Kidney Injury)

Question 1

AKIKI clinical question

Answer 1

Among ICU patients with AKI, does early renal replacement therapy (RRT) reduce mortality as compared to delayed RRT

Question 2

AKIKI bottom line

Answer 2

Among ICU patients with AKI, there is no mortality difference between early or delayed RRT.

Question 3

AKIKI primary outcome

Answer 3

overall survival at day 60.

Question 4

AKIKI inclusion criteria

Answer 4

• Age ≥18 years
• Admitted to ICU with KDIGO Stage 3 AKI that is due to ischemic or toxic acute tubular necrosis, with one of the following:
• -Serum creatinine concentration> 4 mg/dl (354 µmol/l)
• • > 3 times the baseline level
• -Urine output ≤100 ml/day for >12 hours or <500 ml/day or <0.3 ml/kg/h for >24 hours
• ≥1 of the following:
• -Mechanical ventilation
• -Vasopressor support with epinephrine or norepinephrine

Question 5

AKIKI interventions

Answer 5

Patients were randomized within 5 hours after confirming a stage 3 AKI to a group:

• Early RRT - Therapy immediately after randomization (within 6 hours after confirming stage 3 AKI)
• Delayed RRT - Therapy commenced only when meeting 1 of the laboratory abnormalities listed in the exclusion criteria, or if oliguria or anuria lasted >72 hours post-randomization

Question 6

AKIKI Criticisms

Answer 6

• Limited generalizability as ~50% of patients received intermittent HD and only 30% received continuous RRT
• It is debatable if the trial was sufficiently powered to detect a significant difference in mortality.
• Trial results may not be applicable to patients with less severe renal disease.
• The Kt/V was not used to evaluate the dose of RRT, however, low serum urea levels were maintained during treatment