Timing of renal replacement therapy and patient outcomes in the randomized evaluation of normal versus augmented level of replacement therapy study

Min Jun, Rinaldo Bellomo, Alan Cass, Martin Gallagher, S Lo, Joanne Lee, RENAL Randomized Evaluation of Normal Versus Augmented Level of Replacement Therapy

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Objectives: To explore the relationship between timing of continuous renal replacement therapy commencement and clinical outcomes in critically ill patients with acute kidney injury. The primary outcomes were all-cause mortality at 28 and 90 days.

    Design: Nested observational cohort study using data from the Randomized Evaluation of Normal Versus Augmented Level Replacement Therapy Study.

    Setting: Twenty-three ICUs in Australia and New Zealand.

    Patients: Four hundred thirty-nine critically ill patients with acute kidney injury Risk, Injury, Failure, Loss, End-stage kidney disease-injury (RIFLE-I) criteria.

    Interventions: None.

    Measurements and main results: The time between RIFLE-I acute kidney injury and randomization in the Randomized Evaluation of Normal Versus Augmented Level Replacement Therapy Study (proxy for continuous renal replacement therapy commencement) was the variable of interest. All baseline variables in the Randomized Evaluation of Normal Versus Augmented Level Replacement Therapy Study were assessed. Multivariable Cox, logistic, and linear regression models were used to assess the independent relationship of time of onset of RIFLE-I acute kidney injury and randomization and patient outcomes. The median time between RIFLE-I acute kidney injury and continuous renal replacement therapy commencement was 17.6 hours (interquartile range, 7.1-46 hr). Based on four groups of continuous renal replacement therapy commencement ([group 1; reference]: < 7.1, [group 2]: ? 7.1 to < 17.6, [group 3]: ? 17.6 to < 46.0, [group 4]: ? 46.0 hr), earlier commencement of continuous renal replacement therapy was not associated with a significantly lower risk of death at 28 days (hazard ratio for group 2: 1.06, 95% CI: 0.62-1.81; p = 0.83; hazard ratio for group 3: 1.23, 95% CI: 0.71-2.12; p = 0.46; hazard ratio for group 4: 1.33, 95% CI: 0.77-2.31; p = 0.31). Similar findings were observed for death at 90 days.

    Conclusions: In a subgroup of participants of the Randomized Evaluation of Normal Versus Augmented Level Replacement Therapy Study, earlier commencement of continuous renal replacement therapy relative to RIFLE-I acute kidney injury was not significantly associated with improved survival. Additional studies with larger sample sizes and broader commencement times are warranted.

    Original languageEnglish
    Pages (from-to)1756-1765
    Number of pages10
    JournalCritical Care Medicine
    Volume42
    Issue number8
    DOIs
    Publication statusPublished - 2014

    Fingerprint

    Renal Replacement Therapy
    Acute Kidney Injury
    Random Allocation
    Critical Illness
    Linear Models
    Therapeutics
    Wounds and Injuries
    Proxy
    New Zealand
    Sample Size
    Chronic Kidney Failure
    Observational Studies
    Cohort Studies
    Logistic Models
    Survival
    Mortality

    Cite this

    Jun, M., Bellomo, R., Cass, A., Gallagher, M., Lo, S., Lee, J., & Randomized Evaluation of Normal Versus Augmented Level of Replacement Therapy, RENAL. (2014). Timing of renal replacement therapy and patient outcomes in the randomized evaluation of normal versus augmented level of replacement therapy study. Critical Care Medicine, 42(8), 1756-1765. https://doi.org/10.1097/CCM.0000000000000343
    Jun, Min ; Bellomo, Rinaldo ; Cass, Alan ; Gallagher, Martin ; Lo, S ; Lee, Joanne ; Randomized Evaluation of Normal Versus Augmented Level of Replacement Therapy, RENAL. / Timing of renal replacement therapy and patient outcomes in the randomized evaluation of normal versus augmented level of replacement therapy study. In: Critical Care Medicine. 2014 ; Vol. 42, No. 8. pp. 1756-1765.
    @article{6511e41bf41848a09732702727c1ca77,
    title = "Timing of renal replacement therapy and patient outcomes in the randomized evaluation of normal versus augmented level of replacement therapy study",
    abstract = "Objectives: To explore the relationship between timing of continuous renal replacement therapy commencement and clinical outcomes in critically ill patients with acute kidney injury. The primary outcomes were all-cause mortality at 28 and 90 days. Design: Nested observational cohort study using data from the Randomized Evaluation of Normal Versus Augmented Level Replacement Therapy Study. Setting: Twenty-three ICUs in Australia and New Zealand. Patients: Four hundred thirty-nine critically ill patients with acute kidney injury Risk, Injury, Failure, Loss, End-stage kidney disease-injury (RIFLE-I) criteria. Interventions: None. Measurements and main results: The time between RIFLE-I acute kidney injury and randomization in the Randomized Evaluation of Normal Versus Augmented Level Replacement Therapy Study (proxy for continuous renal replacement therapy commencement) was the variable of interest. All baseline variables in the Randomized Evaluation of Normal Versus Augmented Level Replacement Therapy Study were assessed. Multivariable Cox, logistic, and linear regression models were used to assess the independent relationship of time of onset of RIFLE-I acute kidney injury and randomization and patient outcomes. The median time between RIFLE-I acute kidney injury and continuous renal replacement therapy commencement was 17.6 hours (interquartile range, 7.1-46 hr). Based on four groups of continuous renal replacement therapy commencement ([group 1; reference]: < 7.1, [group 2]: ? 7.1 to < 17.6, [group 3]: ? 17.6 to < 46.0, [group 4]: ? 46.0 hr), earlier commencement of continuous renal replacement therapy was not associated with a significantly lower risk of death at 28 days (hazard ratio for group 2: 1.06, 95{\%} CI: 0.62-1.81; p = 0.83; hazard ratio for group 3: 1.23, 95{\%} CI: 0.71-2.12; p = 0.46; hazard ratio for group 4: 1.33, 95{\%} CI: 0.77-2.31; p = 0.31). Similar findings were observed for death at 90 days. Conclusions: In a subgroup of participants of the Randomized Evaluation of Normal Versus Augmented Level Replacement Therapy Study, earlier commencement of continuous renal replacement therapy relative to RIFLE-I acute kidney injury was not significantly associated with improved survival. Additional studies with larger sample sizes and broader commencement times are warranted.",
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    author = "Min Jun and Rinaldo Bellomo and Alan Cass and Martin Gallagher and S Lo and Joanne Lee and {Randomized Evaluation of Normal Versus Augmented Level of Replacement Therapy}, RENAL",
    year = "2014",
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    language = "English",
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    pages = "1756--1765",
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    Jun, M, Bellomo, R, Cass, A, Gallagher, M, Lo, S, Lee, J & Randomized Evaluation of Normal Versus Augmented Level of Replacement Therapy, RENAL 2014, 'Timing of renal replacement therapy and patient outcomes in the randomized evaluation of normal versus augmented level of replacement therapy study', Critical Care Medicine, vol. 42, no. 8, pp. 1756-1765. https://doi.org/10.1097/CCM.0000000000000343

    Timing of renal replacement therapy and patient outcomes in the randomized evaluation of normal versus augmented level of replacement therapy study. / Jun, Min; Bellomo, Rinaldo; Cass, Alan; Gallagher, Martin; Lo, S; Lee, Joanne; Randomized Evaluation of Normal Versus Augmented Level of Replacement Therapy, RENAL.

    In: Critical Care Medicine, Vol. 42, No. 8, 2014, p. 1756-1765.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Timing of renal replacement therapy and patient outcomes in the randomized evaluation of normal versus augmented level of replacement therapy study

    AU - Jun, Min

    AU - Bellomo, Rinaldo

    AU - Cass, Alan

    AU - Gallagher, Martin

    AU - Lo, S

    AU - Lee, Joanne

    AU - Randomized Evaluation of Normal Versus Augmented Level of Replacement Therapy, RENAL

    PY - 2014

    Y1 - 2014

    N2 - Objectives: To explore the relationship between timing of continuous renal replacement therapy commencement and clinical outcomes in critically ill patients with acute kidney injury. The primary outcomes were all-cause mortality at 28 and 90 days. Design: Nested observational cohort study using data from the Randomized Evaluation of Normal Versus Augmented Level Replacement Therapy Study. Setting: Twenty-three ICUs in Australia and New Zealand. Patients: Four hundred thirty-nine critically ill patients with acute kidney injury Risk, Injury, Failure, Loss, End-stage kidney disease-injury (RIFLE-I) criteria. Interventions: None. Measurements and main results: The time between RIFLE-I acute kidney injury and randomization in the Randomized Evaluation of Normal Versus Augmented Level Replacement Therapy Study (proxy for continuous renal replacement therapy commencement) was the variable of interest. All baseline variables in the Randomized Evaluation of Normal Versus Augmented Level Replacement Therapy Study were assessed. Multivariable Cox, logistic, and linear regression models were used to assess the independent relationship of time of onset of RIFLE-I acute kidney injury and randomization and patient outcomes. The median time between RIFLE-I acute kidney injury and continuous renal replacement therapy commencement was 17.6 hours (interquartile range, 7.1-46 hr). Based on four groups of continuous renal replacement therapy commencement ([group 1; reference]: < 7.1, [group 2]: ? 7.1 to < 17.6, [group 3]: ? 17.6 to < 46.0, [group 4]: ? 46.0 hr), earlier commencement of continuous renal replacement therapy was not associated with a significantly lower risk of death at 28 days (hazard ratio for group 2: 1.06, 95% CI: 0.62-1.81; p = 0.83; hazard ratio for group 3: 1.23, 95% CI: 0.71-2.12; p = 0.46; hazard ratio for group 4: 1.33, 95% CI: 0.77-2.31; p = 0.31). Similar findings were observed for death at 90 days. Conclusions: In a subgroup of participants of the Randomized Evaluation of Normal Versus Augmented Level Replacement Therapy Study, earlier commencement of continuous renal replacement therapy relative to RIFLE-I acute kidney injury was not significantly associated with improved survival. Additional studies with larger sample sizes and broader commencement times are warranted.

    AB - Objectives: To explore the relationship between timing of continuous renal replacement therapy commencement and clinical outcomes in critically ill patients with acute kidney injury. The primary outcomes were all-cause mortality at 28 and 90 days. Design: Nested observational cohort study using data from the Randomized Evaluation of Normal Versus Augmented Level Replacement Therapy Study. Setting: Twenty-three ICUs in Australia and New Zealand. Patients: Four hundred thirty-nine critically ill patients with acute kidney injury Risk, Injury, Failure, Loss, End-stage kidney disease-injury (RIFLE-I) criteria. Interventions: None. Measurements and main results: The time between RIFLE-I acute kidney injury and randomization in the Randomized Evaluation of Normal Versus Augmented Level Replacement Therapy Study (proxy for continuous renal replacement therapy commencement) was the variable of interest. All baseline variables in the Randomized Evaluation of Normal Versus Augmented Level Replacement Therapy Study were assessed. Multivariable Cox, logistic, and linear regression models were used to assess the independent relationship of time of onset of RIFLE-I acute kidney injury and randomization and patient outcomes. The median time between RIFLE-I acute kidney injury and continuous renal replacement therapy commencement was 17.6 hours (interquartile range, 7.1-46 hr). Based on four groups of continuous renal replacement therapy commencement ([group 1; reference]: < 7.1, [group 2]: ? 7.1 to < 17.6, [group 3]: ? 17.6 to < 46.0, [group 4]: ? 46.0 hr), earlier commencement of continuous renal replacement therapy was not associated with a significantly lower risk of death at 28 days (hazard ratio for group 2: 1.06, 95% CI: 0.62-1.81; p = 0.83; hazard ratio for group 3: 1.23, 95% CI: 0.71-2.12; p = 0.46; hazard ratio for group 4: 1.33, 95% CI: 0.77-2.31; p = 0.31). Similar findings were observed for death at 90 days. Conclusions: In a subgroup of participants of the Randomized Evaluation of Normal Versus Augmented Level Replacement Therapy Study, earlier commencement of continuous renal replacement therapy relative to RIFLE-I acute kidney injury was not significantly associated with improved survival. Additional studies with larger sample sizes and broader commencement times are warranted.

    KW - acute kidney failure

    KW - adult

    KW - aged

    KW - article

    KW - Australia and New Zealand

    KW - cohort analysis

    KW - continuous renal replacement therapy

    KW - controlled study

    KW - critically ill patient

    KW - death

    KW - female

    KW - human

    KW - intensive care unit

    KW - major clinical study

    KW - male

    KW - middle aged

    KW - mortality

    KW - priority journal

    KW - randomized controlled trial

    U2 - 10.1097/CCM.0000000000000343

    DO - 10.1097/CCM.0000000000000343

    M3 - Article

    VL - 42

    SP - 1756

    EP - 1765

    JO - Critical Care Medicine

    JF - Critical Care Medicine

    SN - 0090-3493

    IS - 8

    ER -