6/28/23, 11:32 PM IDEAL-ICU Pathway Feedback Search Clinical Topics Home Studies IDEAL ICU IDEAL ICU Disease Disease Acute kidney injury Sepsis and septic shock Trial question What is the role of early strategy for the initiation of RRT among patients with septic shock who had severe AKI? Study design Multi-center Open label RCT Population Characteristics of study participants 39.0% female N = 488 61.0% male 488 patients (192 female, 296 male) Inclusion criteria: patients with early-stage septic shock who had severe AKI at the failure stage of the risk, injury, failure, loss, and end-stage kidney disease classification system but without life-threatening complications related to AKI Key exclusion criteria: requirement of emergency RRT before randomization, chronic renal at dialysis, moribund with life expectancy < 24 hours Interventions N=246 an early strategy (RRT within 12 hours after documentation of failure-stage AKI) N=242 a delayed strategy (RRT after a delay of 48 hours if renal recovery had not occurred) Primary outcome Death at 90 days 58 58 0 % 54 https://web.pathway.md/studies/recWjfQSTo5FzjHJy 1/2 6/28/23, 11:32 PM 58.0 % IDEAL-ICU Pathway 54 43.5 % 29.0 % 14.5 % No significant difference 0.0 % An early strategy A delayed strategy No significant difference in death at 90 days (58% vs. 54%; RR 1.07, 95% CI -1.29 to 3.43) Secondary outcomes Significant decrease in days free of RRT (12 days vs. 16 days; AD -4 days, 95% CI -6.85 to -1.15) No significant difference in days free of mechanical ventilation (2 days vs. 3 days; AD -1 days, 95% CI -2.49 to 0.49) No significant difference in median length of ICU stay (11 days vs. 10 days; AD 1 days, 95% CI -14.97 to 16.97) Safety outcomes No significant difference in other adverse events and fluid balance at any given time. Significant difference in hyperkalemia (0% vs. 4%). Conclusion In patients with early-stage septic shock who had severe AKI at the failure stage of the risk, injury, failure, loss, and end-stage kidney disease classification system but without life- threatening complications related to AKI, an early strategy was not superior to a delayed strategy with respect to death at 90 days. Reference Saber D Barbar, Rapha l Clere-Jehl, Abderrahmane Bourredjem et al. Timing of Renal- Replacement Therapy in Patients with Acute Kidney Injury and Sepsis. N Engl J Med. 2018 Oct 11;379(15):1431-1442. Open reference URL https://web.pathway.md/studies/recWjfQSTo5FzjHJy 2/2