Timing of Renal Support and Outcome of Septic Shock and Acute Respiratory Distress Syndrome. A Post Hoc Analysis of the AKIKI Randomized Clinical Trial

Stéphane Gaudry; David Hajage; Frederique Schortgen; Laurent Martin-Lefevre; Charles Verney; Bertrand Pons; Eric Boulet; Alexandre Boyer; Guillaume Chevrel; Nicolas Lerolle; Dorothée Carpentier; Nicolas de Prost; Alexandre Lautrette; Anne Bretagnol; Julien Mayaux; Saad Nseir; Bruno Mégarbane; Marina Thirion; Jean-Marie Forel; Julien Maizel; Hodane Yonis; Philippe Markowicz; Guillaume Thiery; Florence Tubach; Jean-Damien Ricard; Didier Dreyfuss

doi:10.1164/rccm.201706-1255OC

Article dans une revue

Timing of Renal Support and Outcome of Septic Shock and Acute Respiratory Distress Syndrome. A Post Hoc Analysis of the AKIKI Randomized Clinical Trial

Stéphane Gaudry ^{1, 2} David Hajage ^{3, 4} Frederique Schortgen ⁵ Laurent Martin-Lefevre ⁶ Charles Verney ⁷ Bertrand Pons ⁸ Eric Boulet Alexandre Boyer ⁹ Guillaume Chevrel Nicolas Lerolle ^{10, 11} Dorothée Carpentier ¹² Nicolas de Prost ¹³ Alexandre Lautrette ¹⁴ Anne Bretagnol ¹⁵ Julien Mayaux ¹⁶ Saad Nseir ¹⁷ Bruno Mégarbane ¹⁸ Marina Thirion ¹⁹ Jean-Marie Forel ²⁰ Julien Maizel ^{21, 22} Hodane Yonis Philippe Markowicz Guillaume Thiery ²³ Florence Tubach ³ Jean-Damien Ricard ²⁴ Didier Dreyfuss ^{2, 25}

1 CHU Tenon [APHP]

2 Service de Réanimation Médico-Chirurgicale [Avicenne]

3 Service de Biostatistique Santé Publique et Information Médicale [CHU Pitié-Salpêtrière]

4 SU - Sorbonne Université

5 Service d'anesthésie-réanimation SAMU94-SMUR94 [Mondor]

6 SBIM - Service de biostatistique et information médicale de l’hôpital Saint Louis (Equipe ECSTRA)

7 Service de Néphrologie [Bichat-Claude Bernard]

8 Medical ICU, Avenue Albert Raymond, Saint-Priest en Jarez 42270, France

9 LAAS-ESE - Équipe Énergie et Systèmes Embarqués

LAAS - Laboratoire d'analyse et d'architecture des systèmes

10 CHU Angers - Centre Hospitalier Universitaire d'Angers

11 MITOVASC - Physiopathologie Cardiovasculaire et Mitochondriale

12 Service de soins intensifs [CHU Rouen]

13 Service de réanimation médicale

14 Unité de soins intensifs [Clermont Ferrand]

15 Service de Réanimation Polyvalente - CHR d’Orleans

16 CHU Pitié-Salpêtrière [AP-HP]

17 CHRU Lille - Centre Hospitalier Régional Universitaire [Lille]

18 UPMC - Université Pierre et Marie Curie - Paris 6

19 Hôpital Victor Dupouy

20 APHM - Assistance Publique - Hôpitaux de Marseille

21 Unité Médicale de Soins Intensifs

22 Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux

23 CHU Pointe-à-Pitre/Abymes [Guadeloupe]

24 EEM - Ecologie et Evolution des Microorganismes

25 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution

Abstract :

RATIONALE: The optimal strategy for initiation of renal replacement therapy (RRT) in patients with severe acute kidney injury in the context of septic shock and acute respiratory distress syndrome (ARDS) is unknown.

OBJECTIVES: To examine the effect of an early compared with a delayed RRT initiation strategy on 60-day mortality according to baseline sepsis status, ARDS status, and severity.

METHODS: Post hoc analysis of the AKIKI (Artificial Kidney Initiation in Kidney Injury) trial.

MEASUREMENTS AND MAIN RESULTS: Subgroups were defined according to baseline characteristics: sepsis status (Sepsis-3 definition), ARDS status (Berlin definition), Simplified Acute Physiology Score 3 (SAPS 3), and Sepsis-related Organ Failure Assessment (SOFA). Of 619 patients, 348 (56%) had septic shock and 207 (33%) had ARDS. We found no significant influence of the baseline sepsis status (P = 0.28), baseline ARDS status (P = 0.94), and baseline severity scores (P = 0.77 and P = 0.46 for SAPS 3 and SOFA, respectively) on the comparison of 60-day mortality according to RRT initiation strategy. A delayed RRT initiation strategy allowed 45% of patients with septic shock and 46% of patients with ARDS to escape RRT. Urine output was higher in the delayed group. Renal function recovery occurred earlier with the delayed RRT strategy in patients with septic shock or ARDS (P < 0.001 and P = 0.003, respectively). Time to successful extubation in patients with ARDS was not affected by RRT strategy (P = 0.43).

CONCLUSIONS: Early RRT initiation strategy was not associated with any improvement of 60-day mortality in patients with severe acute kidney injury and septic shock or ARDS. Unnecessary and potentially risky procedures might often be avoided in these fragile populations. Clinical trial registered with www.clinicaltrials.gov (NCT 01932190).

Keywords : Acute kidney injury Acute respiratory distress syndrome Mechanical ventilation Renal Replacement Therapy septic shock

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Article dans une revue

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Sciences du Vivant [q-bio]

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https://hal.univ-angers.fr/hal-02616898
Contributeur : Okina Université d'Angers <>
Soumis le : lundi 25 mai 2020 - 03:36:20
Dernière modification le : vendredi 11 juin 2021 - 08:38:03

Timing of Renal Support and Outcome of Septic Shock and Acute Respiratory Distress Syndrome. A Post Hoc Analysis of the AKIKI Randomized Clinical Trial

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Timing of Renal Support and Outcome of Septic Shock and Acute Respiratory Distress Syndrome. A Post Hoc Analysis of the AKIKI Randomized Clinical Trial

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