Renal replacement therapy (RRT) techniques and treatment regimens may influence kidney recovery in critically sick patients with acute kidney damage. The purpose of this research was to compare the outcomes of the “Randomized Evaluation of Normal versus Augmented Level of RRT” and the “Acute Renal Failure Trial Network” (ATN) studies to determine the effects of RRT modality and treatment protocol on RRT dependence. The primary measure was a patient’s reliance on a renal replacement therapy device after 28 days. The requirement for RRT as a secondary outcome was measured both overall and in relation to the various SOFA-based treatment regimen groups. Researchers calculated the sub-distribution hazard ratio (SHR) to evaluate the primary outcome using the Fine-Gray competing-risk model. In order to remove any bias, the analysis was modified to account for potential confounders. The majority of the 2,542 patients (2175; 85.5%) were treated with continuous RRT (CRRT), while 367 (14.4%) were treated with IHD as their initial RRT modality. Patients who underwent CRRT first were more severely ill. No significant difference in 28-day RRT dependence or hospital mortality was found across groups after adjustment (SHR, 0.96 [95% CI 0.84-1.10]; P=0.570; OR, 1.14 [95% CI 0.86-1.52]; P=0.361). The odds of needing RRT after 28 days were lower for survivors who received CRRT initially (OR, 0.54 [95% CI 0.37-0.80]; P=0.002), whereas they were higher for those who did not receive CRRT at all (OR, 1.38 [95% CI 1.11-1.71]). In addition, the ATN treatment protocol was linked to higher mortality and a 4-fold increase in RRT reliance by day 28 among CRRT-first patients and fewer days without the need for RRT. On day 28, there was no distinction between Ischemic Heart Disease (IHD) and Continuous Renal Replacement Therapy (CRRT) in terms of RRT dependence. However, among those who made it to 28 days post-randomization, the IHD-first and ATN treatment protocols were both substantially related to an increased likelihood of RRT dependence.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-022-04151-5
