Your browser doesn't support javascript.
loading
A Bayesian reanalysis of the Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial.
Zampieri, Fernando G; da Costa, Bruno R; Vaara, Suvi T; Lamontagne, François; Rochwerg, Bram; Nichol, Alistair D; McGuinness, Shay; McAuley, Danny F; Ostermann, Marlies; Wald, Ron; Bagshaw, Sean M.
Afiliação
  • Zampieri FG; Academic Research Organization, Albert Einstein Hospital, São Paulo, Brazil.
  • da Costa BR; Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building, 8440-112 St NW, Edmonton, AB, T6G2B7, Canada.
  • Vaara ST; Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Canada.
  • Lamontagne F; Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Rochwerg B; Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada.
  • Nichol AD; Centre de Recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada.
  • McGuinness S; Department of Medicine (Division of Critical Care) and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
  • McAuley DF; Department of Critical Care Medicine, University College Dublin Clinical Research Centre at St. Vincent's University Hospital, Dublin, Ireland.
  • Ostermann M; Monash University, Melbourne, Australia.
  • Wald R; Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland and Medical Research Institute of New Zealand, Wellington, New Zealand.
  • Bagshaw SM; The Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, and The Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, UK.
Crit Care ; 26(1): 255, 2022 08 25.
Article em En | MEDLINE | ID: mdl-36008827
BACKGROUND: Timing of initiation of kidney-replacement therapy (KRT) in critically ill patients remains controversial. The Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial compared two strategies of KRT initiation (accelerated versus standard) in critically ill patients with acute kidney injury and found neutral results for 90-day all-cause mortality. Probabilistic exploration of the trial endpoints may enable greater understanding of the trial findings. We aimed to perform a reanalysis using a Bayesian framework. METHODS: We performed a secondary analysis of all 2927 patients randomized in multi-national STARRT-AKI trial, performed at 168 centers in 15 countries. The primary endpoint, 90-day all-cause mortality, was evaluated using hierarchical Bayesian logistic regression. A spectrum of priors includes optimistic, neutral, and pessimistic priors, along with priors informed from earlier clinical trials. Secondary endpoints (KRT-free days and hospital-free days) were assessed using zero-one inflated beta regression. RESULTS: The posterior probability of benefit comparing an accelerated versus a standard KRT initiation strategy for the primary endpoint suggested no important difference, regardless of the prior used (absolute difference of 0.13% [95% credible interval [CrI] - 3.30%; 3.40%], - 0.39% [95% CrI - 3.46%; 3.00%], and 0.64% [95% CrI - 2.53%; 3.88%] for neutral, optimistic, and pessimistic priors, respectively). There was a very low probability that the effect size was equal or larger than a consensus-defined minimal clinically important difference. Patients allocated to the accelerated strategy had a lower number of KRT-free days (median absolute difference of - 3.55 days [95% CrI - 6.38; - 0.48]), with a probability that the accelerated strategy was associated with more KRT-free days of 0.008. Hospital-free days were similar between strategies, with the accelerated strategy having a median absolute difference of 0.48 more hospital-free days (95% CrI - 1.87; 2.72) compared with the standard strategy and the probability that the accelerated strategy had more hospital-free days was 0.66. CONCLUSIONS: In a Bayesian reanalysis of the STARRT-AKI trial, we found very low probability that an accelerated strategy has clinically important benefits compared with the standard strategy. Patients receiving the accelerated strategy probably have fewer days alive and KRT-free. These findings do not support the adoption of an accelerated strategy of KRT initiation.
Assuntos
Palavras-chave

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Estado Terminal / Injúria Renal Aguda Tipo de estudo: Clinical_trials / Prognostic_studies Limite: Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Estado Terminal / Injúria Renal Aguda Tipo de estudo: Clinical_trials / Prognostic_studies Limite: Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article