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Affiliation(s)
- Stéphane Gaudry
- From INSERM, UMR_S1155, Common and Rare Kidney Diseases, Hôpital Tenon, Sorbonne Université (S.G., D.D.), and Université de Paris (D.D.), Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Réanimation Médico-Chirurgicale, and the Health Care Simulation Center, UFR SMBH, Université Paris 13, Sorbonne Paris Cité, Bobigny (S.G.), and Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive-Réanimation, Hôpital Louis Mourier, Colombes (D.D.) - all in France; and the Kidney Medicine Section, Medical Service, Veterans Affairs Pittsburgh Healthcare System, and the Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh - both in Pittsburgh (P.M.P.)
| | - Paul M Palevsky
- From INSERM, UMR_S1155, Common and Rare Kidney Diseases, Hôpital Tenon, Sorbonne Université (S.G., D.D.), and Université de Paris (D.D.), Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Réanimation Médico-Chirurgicale, and the Health Care Simulation Center, UFR SMBH, Université Paris 13, Sorbonne Paris Cité, Bobigny (S.G.), and Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive-Réanimation, Hôpital Louis Mourier, Colombes (D.D.) - all in France; and the Kidney Medicine Section, Medical Service, Veterans Affairs Pittsburgh Healthcare System, and the Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh - both in Pittsburgh (P.M.P.)
| | - Didier Dreyfuss
- From INSERM, UMR_S1155, Common and Rare Kidney Diseases, Hôpital Tenon, Sorbonne Université (S.G., D.D.), and Université de Paris (D.D.), Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Réanimation Médico-Chirurgicale, and the Health Care Simulation Center, UFR SMBH, Université Paris 13, Sorbonne Paris Cité, Bobigny (S.G.), and Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive-Réanimation, Hôpital Louis Mourier, Colombes (D.D.) - all in France; and the Kidney Medicine Section, Medical Service, Veterans Affairs Pittsburgh Healthcare System, and the Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh - both in Pittsburgh (P.M.P.)
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Andonovic M, Shemilt R, Sim M, Traynor JP, Shaw M, Mark PB, Puxty KA. Timing of renal replacement therapy for patients with acute kidney injury: A systematic review and meta-analysis. J Intensive Care Soc 2021; 22:67-77. [PMID: 33643435 PMCID: PMC7890756 DOI: 10.1177/1751143720901688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Acute kidney injury is associated with high mortality, and the optimal time to start renal replacement therapy for acute kidney injury is unknown despite several randomised controlled trials on the subject. We performed a systematic review and meta-analysis to assess the effect of earlier initiation of renal replacement therapy for acute kidney injury on mortality and reported secondary outcomes. METHODS All literature in databases EMBASE, MEDLINE and CENTRAL was searched from January 1970 to March 2019 using terms related to renal replacement therapy, timing and randomised controlled trials. All randomised controlled trials with 25 or more adult participants suffering from acute kidney injury comparing timing of renal replacement therapy were included. The results of the selected studies were pooled and expressed in terms of risk ratios (RR) and 95% confidence intervals (95% CI) using a random effects model. RESULTS A total of 7008 records were identified; 94 were selected for full text review of which 10 were included in the final meta-analysis. The 10 studies comprised 1956 participants (989 'early' group; 967 'late' group) with 918 total deaths; the analysis demonstrated no significant differences between the 'early' and 'late' renal replacement therapy groups (RR = 0.98 (95% CI = 0.84, 1.15)) for mortality. No significant differences between groups were evident for period-wise mortality; dialysis dependence; recovery of renal function; length of intensive care unit or hospital stay; or number of renal replacement therapies, mechanical ventilation and vasopressor-free days. CONCLUSIONS Current evidence does not support the use of early renal replacement therapy for patients with acute kidney injury. Data from ongoing and future randomised controlled trials are required to strengthen the evidence base in the area.
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Affiliation(s)
- Mark Andonovic
- Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow, UK
| | - Richard Shemilt
- Department of Nephrology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Malcolm Sim
- Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow, UK
- Department of Intensive Care, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jamie P Traynor
- Department of Nephrology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Martin Shaw
- Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow, UK
| | - Patrick B Mark
- Department of Nephrology, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kathryn A Puxty
- Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow, UK
- Department of Intensive Care Medicine, Glasgow Royal Infirmary, Glasgow, UK
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3
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Gaudry S, Palevsky PM, Dreyfuss D. Interpreting trials on renal replacement therapy initiation: beware of methodologic issues. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:240. [PMID: 32430071 PMCID: PMC7236264 DOI: 10.1186/s13054-020-02961-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Stéphane Gaudry
- Département de réanimation médico-chirurgicale, APHP Hôpital Avicenne, Université Sorbonne Paris Nord, Bobigny, France.,Common and Rare Kidney Diseases, French National Institute of Health and Medical Research, INSERM UMR_S 1155, Sorbonne Université, Paris, France.,Health Care Simulation Center, UFR SMBH Université Sorbonne Paris Nord, Bobigny, France
| | - Paul M Palevsky
- Renal Section, Medical Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Didier Dreyfuss
- Common and Rare Kidney Diseases, French National Institute of Health and Medical Research, INSERM UMR_S 1155, Sorbonne Université, Paris, France. .,AP-HP, Médecine Intensive-Réanimation, Hôpital Louis Mourier, 92700, Colombes, France. .,Université de Paris, Paris, France. .,Present address: Médecine Intensive-Réanimation, Hôpital Louis Mourier, 178 rue des Renouillers, 92110, Colombes, France.
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Gaudry S, Quenot JP, Hertig A, Barbar SD, Hajage D, Ricard JD, Dreyfuss D. Timing of Renal Replacement Therapy for Severe Acute Kidney Injury in Critically Ill Patients. Am J Respir Crit Care Med 2020; 199:1066-1075. [PMID: 30785784 DOI: 10.1164/rccm.201810-1906cp] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Acute kidney injury (AKI) affects many ICU patients and is responsible for increased morbidity and mortality. Although lifesaving in many situations, renal replacement therapy (RRT) may be associated with complications, and the appropriate timing of its initiation is still the subject of intense debate. An early initiation strategy can prevent some metabolic complications, whereas a delayed one may allow for renal function recovery in some patients without need for this costly and potentially dangerous technique. For years, most of the knowledge on this issue stemmed from observational studies or small randomized controlled trials. Recent randomized controlled trials have indicated that a watchful waiting strategy (in the absence of life-threatening conditions such as severe hyperkalemia or pulmonary edema) during severe AKI allowed many patients to escape RRT and did not seem to adversely affect survival compared with a strategy of immediate RRT. In addition, data suggest that a delayed strategy may reduce the rate of complications (such as catheter infection) and favor renal function recovery. Ongoing studies will have to both confirm these conclusions and clarify to what extent the delay in initiating RRT can be prolonged. Pending those results, the bulk of evidence suggests that, in the absence of potential severe complications of AKI, delaying RRT is a valid and safe strategy that may also allow for considerable cost savings.
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Affiliation(s)
- Stéphane Gaudry
- 1 AP-HP, Hôpital Avicenne, Service de Réanimation Médico-Chirurgicale, Bobigny, France.,2 INSERM UMR S 1155 "Common and Rare Kidney Diseases: from Molecular Events to Precision Medicine," and.,3 Health Care Simulation Center, UFR SMBH, Université Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - Jean-Pierre Quenot
- 4 Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,5 Lipness Team, INSERM Research Center, LNC-UMR1231 and LabEx LipSTIC, and.,6 INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Alexandre Hertig
- 2 INSERM UMR S 1155 "Common and Rare Kidney Diseases: from Molecular Events to Precision Medicine," and.,7 Renal ICU and Transplantation, Sorbonne Universités, Hôpital Tenon, AP-HP, Paris, France
| | - Saber Davide Barbar
- 8 Unité de Réanimation Médicale, CHU de Nîmes - Hôpital Carémeau, Nîmes, France
| | - David Hajage
- 9 Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, CIC-1421, AP-HP, Hôpital Pitié Salpêtrière, Paris, France.,10 INSERM, UMR 1123, ECEVE, Paris, France
| | - Jean-Damien Ricard
- 11 AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France.,12 IAME, UMRS 1137, University Paris Diderot, Sorbonne Paris Cité, Paris, France.,13 INSERM, IAME, U1137, Paris, France; and
| | - Didier Dreyfuss
- 2 INSERM UMR S 1155 "Common and Rare Kidney Diseases: from Molecular Events to Precision Medicine," and.,11 AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France.,14 University Paris Diderot, Sorbonne Paris Cité, Paris, France
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Barbar SD, Gaudry S, Dreyfuss D, Quenot JP. Renal replacement therapy: Time to give up on early initiation? Yes. Anaesth Crit Care Pain Med 2019; 37:501-503. [PMID: 30573205 DOI: 10.1016/j.accpm.2018.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Saber Davide Barbar
- Department of intensive care medicine, Nîmes University Hospital, place du prof. Robert-Debré, 30029 Nîmes, France.
| | - Stephane Gaudry
- Department of surgical and medical intensive care, Avicenne Hospital, AP-HP, 125, rue de Stalingrad, 93000 Bobigny, France; Remodelling and Repair of Renal Tissue, Tenon Hospital, French national institute of health and medical research (Inserm), UMR_S1155, 75020 Paris, France
| | - Didier Dreyfuss
- Department of surgical and medical intensive care, Avicenne Hospital, AP-HP, 125, rue de Stalingrad, 93000 Bobigny, France; Paris Diderot University, Sorbonne Paris Cité, IAME, UMRS 1137, 75018 Paris, France; Inserm, IAME, U1137, 75018 Paris, France
| | - Jean-Pierre Quenot
- Department of intensive care medicine, Dijon Bourgogne university hospital, 14, rue Paul-Gaffarel, 21000 Dijon, France; Bourgogne Franche-Comté university, Lipness Team UMR 1231 et LabExLipSTIC, 21000 Dijon, France; Inserm CIC 1432 Clinical Epidemiology and clinical trial, Dijon Bourgogne university hospital, 21000 Dijon, France
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Douglas IS, Bednash JS, Fein DG, Mallampalli RK, Mansoori JN, Gershengorn HB. Update in Critical Care and Acute Respiratory Distress Syndrome 2018. Am J Respir Crit Care Med 2019; 199:1335-1343. [PMID: 30958975 DOI: 10.1164/rccm.201903-0550up] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Ivor S Douglas
- 1 Pulmonary, Sleep and Critical Care Medicine, Department of Medicine, Denver Health Medical Center, Denver, Colorado
| | - Joseph S Bednash
- 2 Acute Lung Injury Center of Excellence, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Rama K Mallampalli
- 4 Department of Medicine, The Ohio State University, Columbus, Ohio; and
| | - Jason N Mansoori
- 1 Pulmonary, Sleep and Critical Care Medicine, Department of Medicine, Denver Health Medical Center, Denver, Colorado
| | - Hayley B Gershengorn
- 5 Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Miller School of Medicine, University of Miami, Miami, Florida
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Chaïbi K, Barbar S, Quenot JP, Dreyfuss D, Gaudry S. Retarder une épuration extrarénale dans l’insuffisance rénale aiguë : la nuit nous appartient. MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2018-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les indications de l’épuration extrarénale (EER) dans le contexte d’insuffisance rénale aiguë en réanimation sont débattues avec une certaine passion. Il est évident que les situations qui peuvent menacer immédiatement le pronostic vital (hyperkaliémie ou acidose métabolique réfractaire et sévère ou oedème pulmonaire de surcharge chez le patient anurique) nécessitent un recours urgent à l’EER. Hormis ces situations extrêmes, des études de haut niveau de preuve ont récemment montré que retarder l’indication de l’EER n’affecte pas la survie des patients et pourrait même favoriser la récupération de la fonction rénale par comparaison à une EER trop précoce. Cette mise au point se propose de discuter les risques théoriques liés au fait de différer l’EER et s’attache à montrer qu’ils constituent plus des craintes que des réalités.
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