6/28/23, 9:52 PM ELAIN Pathway Feedback Search Clinical Topics Home Studies ELAIN ELAIN Disease Acute kidney injury Trial question What is the effect of early initiation of RRT among 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: preexisting CKD; previous RRT; glomerulonephritis; interstitial nephritis; vasculitis; HUS; TTP Interventions N=112 early RRT (initiation within 8 hours of diagnosis of stage 2 AKI) N=119 delayed RRT (initiation within 12 hours of stage 3 AKI) Primary outcome Death from all causes at day 90 54.7 % 54.7 41.0 % 39.3 27 4 % https://web.pathway.md/studies/recXMSMeToWCZiXtM 1/2 6/28/23, 9:52 PM 27.4 % ELAIN Pathway Significant decrease 13.7 % NNT = 6 0.0 % Early renal replacement therapy Delayed renal replacement therapy Significant decrease in death from all causes at day 90 (39.3% vs. 54.7%; HR 0.66, 95% CI 0.45 to 0.97) Secondary outcomes Significant decrease in duration of RRT (9 days vs. 25 days; HR 0.69, 95% CI 0.48 to 1) Significant decrease in deterioration of renal function at day 90 (38.7% vs. 53.6%; OR 0.55, 95% CI 0.32 to 0.93) Significant decrease in length of hospital stay (51 days vs. 82 days; HR 0.34, 95% CI 0.22 to 0.52) Safety outcomes No significant differences in organ dysfunction, adverse events, RRT-related complications. Significant differences in interleukin-8 concentration at day 1 (65.7 pg/mL vs. 215.5 pg/mL), IL- 6 concentration at day 1 (399.4 pg/mL vs. 989.3 pg/mL). Conclusion In critically ill patients with AKI, early RRT was superior to delayed RRT with respect to death from all causes at day 90. Reference Alexander Zarbock, John A Kellum, Christoph Schmidt et al. Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury: The ELAIN Randomized Clinical Trial. JAMA. 2016 May 24-31;315(20):2190-9. Open reference URL https://web.pathway.md/studies/recXMSMeToWCZiXtM 2/2