RESUMO
BACKGROUND: Lower delivered dose of acute peritoneal dialysis (PD) in AKI requires less resources but raises concerns regarding adequate solute and water clearance. The relative merits of lower dose PD versus intermittent hemodialysis (HD) remain uncertain. METHODS: A multicenter randomized controlled trial compared the outcomes between acute lower dosage PD (18-24 liters per day) and Intermittent HD (three times per week) from May 2018 to January 2021 in patients with AKI. The primary outcome was 28-day mortality rate. Secondary outcomes included 28-day dialysis-free survival and kidney recovery, metabolic profile, and procedure-related complications. Non-inferiority of PD to HD would be demonstrated if the upper bound of the 95% confidence interval (CI) on risk difference (PD-HD) in 28-day mortality rates between the two groups was less than 20%. RESULTS: We included 157 patients (80 allocated to PD and 77 to intermittent HD). Before kidney replacement therapy initiation, baseline clinical characteristics between groups were comparable. Overall mean age was 57 ± 15 years old. The most frequent cause of AKI was sepsis (68%). There was no difference in 28-day mortality between acute PD and intermittent HD (50 vs 49%, risk difference 0.6 (95% CI -15.0,16.3), and 28-day dialysis-free survival (42% vs 37%, risk difference 4.6 (95% CI -11.1,20.3)). Mean weekly Kt/V urea were 2.11 ± 1.14 and 2.55 ± 1.11 in the PD and intermittent HD groups, respectively. The 7-day fluid balance of PD and intermittent HD patients were not significantly different. There was more frequent intradialytic hypotension in the intermittent HD group and more frequent hypokalemia in the PD group. CONCLUSIONS: In this study of patients with AKI, there was no significant difference in 28-day mortality between acute PD and intermittent HD.
RESUMO
BACKGROUND: There is little known about the contribution of microRNAs (miRNAs) in the recovery from acute kidney injury (AKI). This study aimed to discover and validate miRNA profiles for predicting renal recovery from severe AKI. PATIENTS AND METHODS: A prospective observational study was conducted between June 2020 and January 2021. Urine and serum samples of participants with AKI stage 3 were collected from two groups: renal recovery and renal non-recovery. Transcriptomic analysis was performed using nCounter miRNA Expression Assay. Expression levels of candidate miRNAs were validated using quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: The discovery phase identified 18 and 11 differentially expressed miRNAs that were statistically significant between the two groups in urine and serum specimens, respectively. Top candidate miRNAs selected included miR-556-3p, miR-1915-3p, miR-4284, miR-32-5p, miR-96-5p, and miR-556-5p in urine, and miR-499b-5p, miR-30a-3p, miR-92b-3p and miR-770-5p in serum. This study enrolled 110 participants in the validation phase. The qRT-PCR analysis indicated that urine miR-556-3p was significantly higher in the renal recovery group than in the renal non-recovery group. Urine miR-556-3p alone predicted renal recovery with an area under the curve (AUC) of 0.64 (95%CI 0.52-0.75, p = 0.03). Combining the clinical model with urine miR-556-3p predicted renal recovery with an AUC of 0.83 (95%CI 0.75-0.92, p < 0.01). CONCLUSION: This data provides evidence that microtranscriptome profiles of severe AKI patients with renal recovery differed from the non-recovery group. Urine miR-556-3p had the potential to improve the prediction of renal recovery from severe AKI.