کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
6163446 | 1249431 | 2015 | 8 صفحه PDF | دانلود رایگان |
عنوان انگلیسی مقاله ISI
Comparison of standard and accelerated initiation of renal replacement therapy in acute kidney injury
ترجمه فارسی عنوان
مقایسه روش استاندارد و تسریع در درمان جایگزینی کلیه در ضایعات حاد کلیه
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کلمات کلیدی
آسیب حاد کلیه، آزمایش تصادفی کنترل شده درمان جایگزینی کلیه،
موضوعات مرتبط
علوم پزشکی و سلامت
پزشکی و دندانپزشکی
بیماریهای کلیوی
چکیده انگلیسی
In patients with severe acute kidney injury (AKI) but no urgent indication for renal replacement therapy (RRT), the optimal time to initiate RRT remains controversial. While starting RRT preemptively may have benefits, this may expose patients to unnecessary RRT. To study this, we conducted a 12-center open-label pilot trial of critically ill adults with volume replete severe AKI. Patients were randomized to accelerated (12âh or less from eligibility) or standard RRT initiation. Outcomes were adherence to protocol-defined time windows for RRT initiation (primary), proportion of eligible patients enrolled, follow-up to 90 days, and safety in 101 fully eligible patients (57 with sepsis) with a mean age of 63 years. Median serum creatinine and urine output at enrollment were 268âmicromoles/l and 356âml per 24âh, respectively. In the accelerated arm, all patients commenced RRT and 45/48 did so within 12âh from eligibility (median 7.4âh). In the standard arm, 33 patients started RRT at a median of 31.6âh from eligibility, of which 19 did not receive RRT (6 died and 13 recovered kidney function). Clinical outcomes were available for all patients at 90 days following enrollment, with mortality 38% in the accelerated and 37% in the standard arm. Two surviving patients, both randomized to standard RRT initiation, were still RRT dependent at day 90. No safety signal was evident in either arm. Our findings can inform the design of a large-scale effectiveness randomized control trial.
ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Kidney International - Volume 88, Issue 4, October 2015, Pages 897-904
Journal: Kidney International - Volume 88, Issue 4, October 2015, Pages 897-904
نویسندگان
Ron Wald, Neill K.J. Adhikari, Orla M. Smith, Matthew A. Weir, Karen Pope, Ashley Cohen, Kevin Thorpe, Lauralyn McIntyre, Francois Lamontagne, Mark Soth, Margaret Herridge, Stephen Lapinsky, Edward Clark, Amit X. Garg, Swapnil Hiremath, David Klein,