Renal Replacement Therapy

Question 1

ATN (2008)

Answer 1

In critically ill patients with acute tubular necrosis, more intensive renal replacement therapy does not improve all-cause mortality at 60 days compared to conventional less-intensive therapy. In the ATN study, intensive RRT did not improve renal function or non renal organ dysfunction, although it was associated with more frequent hypotensive episodes.

Question 2

RENAL (2009)

Answer 2

Increasing the intensity of continuous renal replacement therapy from 25ml/kg/hr to 40ml/kg/hr did not reduce mortality or the rate of dependence on dialysis among critically ill patients at 90 days.

Question 3

AKIKI (2016)

Answer 3

Among ICU patients with AKI, there is no mortality difference between early or delayed RRT.
Published in 2016, the Artificial Kidney Initiation in Kidney Injury (AKIKI) trial randomized patients to received early (n=311) or delayed RRT (n=308). The primary outcome was overall survival at day 60. Early RRT did not reduce mortality as compared to delayed RRT (48.5% vs. 49.7%; P=0.79). There was a significant increase in catheter-related bloodstream infection in the early RRT group. In the delayed RRT group, 49% of patients never received RRT.

Question 4

VANISH (2016)

Answer 4

Among adults with septic sock, the early use of vasopressin compared with norepinephrine did not improve the number of kidney failure free days. Early vasopressin maintains blood pressure and reduces the requirement for norepinephrine and renal replacement therapy. Vasopressin does not reduce the number of renal replacement free days or mortality rate. There was no clinical interaction with hydrocortisone.

Question 5

ELAIN (2016)

Answer 5

Amongst critically unwell patients with AKI, early RRT compared with delayed initiation of RRT reduced mortality over the first 90 days ( 39.3% vs 54.7% 90 day mortality; early vs. late). Almost entirely surgical patients.

Question 6

PRESERVE (2017)

Answer 6

In patients with impaired kidney function, undergoing angiography, there was no benefit from peri-procedural isotonic sodium bicarbonate or oral acetylcysteine with respect to the risk of dialysis, death or acute kidney injury.

Question 7

SPARK (2017)

Answer 7

A furosemide infusion did not change the incidence of progression to a worse degree of kidney injury. No significant difference between the two groups in terms of cumulative fluid balance, serum K/Mg, acid base status and RRT rates or recovery, mortality rates.

Question 8

AMACING (2017)

Answer 8

There is no difference between hydration and no hydration prior to contrast in patients with renal compromise. This excluded ICU/Emerg patients. Hydration is more expensive.