Author: Leo
Keywords: acute | renal injury | early treatment | prognosis | renal
replacement
therapy
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ELAIN clinical trials showed that renal replacement therapy was effective within 8 hours of onset of acute renal injury in stage 2, significantly reducing all-cause mortality within 90 days.
ELAIN clinical trials showed that renal replacement therapy was effective within 8 hours of onset of acute renal injury in stage 2, significantly reducing all-cause mortality within 90 days.
In addition, early intervention shortens other clinical end points, such as dialysis, mechanical ventilation, total hospital stay.
"You do not have a dialysis treatment for a patient who does not need dialysis because there are a lot of complications in dialysis," said Alexander Zarbock, MD, of the University of Münster Affiliated Hospital in Germany.
However, when you combine early clinical conditions with the biomarkers we use, you can predict which patients will experience severe acute kidney injury, "he told Medscape Medical News." With such a way, you can start early kidney replacement treatment. For patients, this is a better result. "
The study was published at the Fifty-third Congress of the European Association for the Study of the European Association for Dialysis and Transplantation (ERA), and was published online at JAMA.
In this multicenter study, Dr. Zarbock and his colleagues were randomized to 112 patients for early treatment. These patients developed acute renal injury 6 hours after the onset of renal replacement therapy; 119 patients were delayed treatment, 2 acute renal injury Median 25.5 hours to start treatment.
All patients were critically ill and had no life-threatening complications. Plasma neutrophil gelatin protein levels exceeded 150 mg / mL, meeting the criteria for acute renal injury in stage 2.
In the 90-day period, the mortality rate in the early treatment group was lower than that in the delayed group (39.3% vs 54.7%, P = 0.03), and the absolute risk of early treatment was reduced by 15.4%. In addition, the secondary end point was better in the early group than in the delay group.
In the 90-day period, the number of patients who recovered renal function in the early group was significantly higher than that in the delayed group (53.6% vs 38.7%; P = 0.2). However, there was no significant difference in dialysis requirements between the two groups in these 90 days.
Interestingly, treatment within 24 hours can have a significant effect on multiple end points, including a 90-day mortality rate. Dr. Glenn Chertow of Stanford University in California and Dr. Wolfgang Winkelmayer of the Baylor College of Medicine in Houston, said in an editorial published in the paper.
However, "other single-center, medium-sized published dialysis intervention trials have achieved equally impressive results," the two pointed out. For example, an 114-patient study showed that patients receiving hemofiltration had lower hospital mortality (2% vs 14%; P = 0.02) than those receiving saline infusions and a 1-year mortality rate 10% vs 30%; P = 0.01) (N Engl J Med. 2003; 349: 1333-1340).
"At the time, many clinicians thought the findings were untrustworthy; no validation tests have been conducted so far," said Chertow and Dr. Winkelmayer.
Dr. Zarbock's findings are credible, "the researchers conducted rigorous trials to present their findings," the authors explained, "taking into account the different findings of Zarbock et al., The researchers of Kidney's First Aid Nursing Have the responsibility to confirm or refute the results of these studies in a larger, diverse population. "
The current controversy is whether early treatment can actually improve the prognosis of patients with acute kidney injury, said Dr. Denis Fouque from the University of Lyon, France.
In a recent multicenter study, there was no significant difference between early treatment and delayed treatment mortality (48.5% vs 49.7%) (N Engl J Med. Published online May 15, 2016). However, diuretic (a sign of improved renal function) occurred early in the delayed group (P <0.001).
"Any treatment can give the patient a certain risk, so if you do not start dialysis, you can avoid dialysis-related complications such as bleeding and catheter-related infections," Dr Fouque explains. "It really depends on the doctor "But relying solely on the number of KDIGO creatures may not be enough to decide when to start treatment."
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