Early versus Late Initiation of Continuous Renal Replacement Therapy in Critically Ill Patients: A Propensity Matched Multicenter Cohort Study

What this Trial Is About

Researchers are investigating the timing of renal replacement therapy (RRT) in critically ill patients suffering from acute kidney injury (AKI), a serious condition affecting kidney function. The study addresses the current lack of consensus about when to start RRT, which is often continuous renal replacement therapy (CRRT) in Sweden. Conflicting results from previous studies and trials have left uncertainty around whether early or late initiation of RRT leads to better patient outcomes, including survival and kidney health. This observational cohort study uses detailed data from over 50,000 ICU patients treated between 2007 and 2017 across three hospitals and five intensive care units in Stockholm. Patients who received CRRT will be categorized into early and late treatment groups based on various clinical and biomarker criteria, such as blood urea nitrogen levels, fluid overload, and timing relative to ICU admission. Some patients who never received RRT will also be included for comparison. The study plans to analyze differences in mortality and morbidity between these groups using advanced statistical methods. Participants' medical records and ICU data will be reviewed for demographic information, illness severity, treatment details, and outcomes. Mortality will be tracked at multiple points up to three years after ICU admission. Morbidity will be assessed by new diagnoses of chronic kidney disease or end-stage renal disease. Lengths of ICU and hospital stays will also be measured. The study aims to provide important insights into the best timing for starting RRT to improve outcomes for critically ill patients with AKI.

Timing of Renal Replacement Therapy in the Critically Ill Patients