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Regional Practice Variation and Outcomes in the Standard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Trial: A Post Hoc Secondary Analysis.
Vaara, Suvi T; Serpa Neto, Ary; Bellomo, Rinaldo; Adhikari, Neill K J; Dreyfuss, Didier; Gallagher, Martin; Gaudry, Stephane; Hoste, Eric; Joannidis, Michael; Pettilä, Ville; Wang, Amanda Y; Kashani, Kianoush; Wald, Ron; Bagshaw, Sean M; Ostermann, Marlies.
Affiliation
  • Vaara ST; Department of Perioperative and Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Serpa Neto A; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
  • Bellomo R; Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, VIC, Australia.
  • Adhikari NKJ; Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
  • Dreyfuss D; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
  • Gallagher M; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
  • Gaudry S; Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, VIC, Australia.
  • Hoste E; Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
  • Joannidis M; Data Analytics Research & Evaluation, Austin Hospital, Melbourne, VIC, Australia.
  • Pettilä V; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.
  • Wang AY; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
  • Kashani K; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
  • Wald R; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
  • Bagshaw SM; French National Institute of Health and Medical Research (INSERM), UMR_S1155, CORAKID, Hôpital Tenon, Sorbonne Université, Paris, France.
  • Ostermann M; Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, Assistance Publique, Université de Paris-Cité, Paris, France.
Crit Care Explor ; 6(2): e1053, 2024 Feb.
Article in En | MEDLINE | ID: mdl-38380940
ABSTRACT

OBJECTIVES:

Among patients with severe acute kidney injury (AKI) admitted to the ICU in high-income countries, regional practice variations for fluid balance (FB) management, timing, and choice of renal replacement therapy (RRT) modality may be significant.

DESIGN:

Secondary post hoc analysis of the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial (ClinicalTrials.gov number NCT02568722).

SETTING:

One hundred-fifty-three ICUs in 13 countries. PATIENTS Altogether 2693 critically ill patients with AKI, of whom 994 were North American, 1143 European, and 556 from Australia and New Zealand (ANZ).

INTERVENTIONS:

None. MEASUREMENTS AND MAIN

RESULTS:

Total mean FB to a maximum of 14 days was +7199 mL in North America, +5641 mL in Europe, and +2211 mL in ANZ (p < 0.001). The median time to RRT initiation among patients allocated to the standard strategy was longest in Europe compared with North America and ANZ (p < 0.001; p < 0.001). Continuous RRT was the initial RRT modality in 60.8% of patients in North America and 56.8% of patients in Europe, compared with 96.4% of patients in ANZ (p < 0.001). After adjustment for predefined baseline characteristics, compared with North American and European patients, those in ANZ were more likely to survive to ICU (p < 0.001) and hospital discharge (p < 0.001) and to 90 days (for ANZ vs. Europe risk difference [RD], -11.3%; 95% CI, -17.7% to -4.8%; p < 0.001 and for ANZ vs. North America RD, -10.3%; 95% CI, -17.5% to -3.1%; p = 0.007).

CONCLUSIONS:

Among STARRT-AKI trial centers, significant regional practice variation exists regarding FB, timing of initiation of RRT, and initial use of continuous RRT. After adjustment, such practice variation was associated with lower ICU and hospital stay and 90-day mortality among ANZ patients compared with other regions.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Renal Replacement Therapy / Acute Kidney Injury / Intensive Care Units Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: America do norte / Europa / Oceania Language: En Journal: Crit Care Explor Year: 2024 Document type: Article Affiliation country: Finland Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Renal Replacement Therapy / Acute Kidney Injury / Intensive Care Units Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: America do norte / Europa / Oceania Language: En Journal: Crit Care Explor Year: 2024 Document type: Article Affiliation country: Finland Country of publication: United States