6/28/23, 9:52 PM ELAIN FOLLOW-UP Pathway Feedback Search Clinical Topics Home Studies ELAIN FOLLOW UP ELAIN FOLLOW UP Disease Acute kidney injury Trial question Is early initiation of RRT superior to late initiation of RRT in critically ill patients with AKI? Study design Single center Open label RCT Population Characteristics of study participants 37.0% female N = 231 63.0% male 231 patients (85 female, 146 male) Inclusion criteria: critically ill patients with AKI Key exclusion criteria: pre-existing kidney disease not requiring RRT; previous RRT; acute renal injury caused by post-renal obstruction; pregnancy Interventions N=111 early RRT initiation (within 8 hours of diagnosis of stage 2 AKI) N=119 late initiation (within 12 hours of diagnosis of stage 3 AKI) Primary outcome Major adverse kidney events consisting of persistent renal dysfunction, dialysis dependence, and death at 1 year 89.1 89.1 % 66.8 % 64.9 https://web.pathway.md/studies/rec2IRD6I5i6miLTX 1/2 6/28/23, 9:52 PM ELAIN FOLLOW-UP Pathway 44.5 % Significant decrease 22.3 % NNT = 4 0.0 % Early renal replacement therapy initiation Late initiation Significant decrease in major adverse kidney events consisting of persistent renal dysfunction, dialysis dependence, and death at 1 year (64.9% vs. 89.1%; OR 0.23, 95% CI 0.11 to 0.45) Secondary outcomes Significant decrease in death from all causes at 1 year (50.2% vs. 69.8%; OR 0.62, 95% CI 0.44 to 0.87) No significant difference in the percentage of patients who require RRT at 1 year (7.3% vs. 11.1%; OR 0.62, 95% CI 0.15 to 2.69) Significant decrease in the percentage of patients with persistent renal dysfunction at 1 year (29.1% vs. 63.9%; OR 0.23, 95% CI 0.09 to 0.57) Safety outcomes No significant differences in death due to refractory septic shock, myocardial dysfunction, stroke, or bleeding. Significant difference in death due to multiple organ dysfunction syndrome (21.4% vs. 38.6%). Conclusion In critically ill patients with AKI, early RRT initiation was superior to late initiation with respect to major adverse kidney events consisting of persistent renal dysfunction, dialysis dependence, and death at 1 year. Reference Melanie Meersch, Mira K llmar, Christoph Schmidt et al. Long-Term Clinical Outcomes after Early Initiation of RRT in Critically Ill Patients with AKI. J Am Soc Nephrol. 2018 Mar;29(3):1011- 1019. Open reference URL https://web.pathway.md/studies/rec2IRD6I5i6miLTX 2/2