Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury

Sean M Bagshaw , Ron Wald , Neill K J Adhikari , Rinaldo Bellomo , Bruno R Da Costa , Didier Dreyfuss , Bin Du , Martin P Gallagher , Stéphane Gaudry , Eric A Hoste , François Lamontagne , Michael Joannidis , Giovanni Landoni , Kathleen D Liu , Daniel F Mcauley , Shay P Mcguinness , Javier A Neyra , Alistair D Nichol , Marlies Ostermann , Paul M Palevsky , Ville Pettilä , Jean-Pierre Quenot , Haibo Qiu , Bram Rochwerg , Antoine G Schneider , Orla M Smith , Fernando Thomé , Kevin E Thorpe , Suvi Vaara , Matthew Weir , Amanda Y Wang , Paul Young , Alexander Zarbock , Rinaldo Bellomo , Glenn M Eastwood , Leah Peck , Helen Young , Peter Kruger , Gordon Laurie , Emma Saylor , Jason Meyer , Ellen Venz , Krista Wetzig , Craig French , Forbes Mcgain , John Mulder , Gerard Fennessy , Sathyajith Koottayi , Samantha Bates , Miriam Towns , Rebecca Morgan , Anna Tippett , Andrew Udy , Chris Mason , Elisa Licari , Dashiell Gantner , Jason Mcclure , Alistair Nichol , Phoebe Mccracken , Jasmin Board , Emma Martin , Shirley Vallance , Meredith Young , Chelsey Vladic , Steve Mcgloughlin , David Gattas , Heidi Buhr , Jennifer Coles , Debra Hutch , James Wun , Louise Cole , Christina Whitehead , Julie Lowrey , Kristy Masters , Rebecca Gresham , Victoria Campbell , David Gutierrez , Jane Brailsford , Loretta Forbes , Lauren Murray , Teena Maguire , Martina Nichonghaile , Neil Orford , Allison Bone , Tania Elderkin , Tania Salerno , Tim Chimunda , Jason Fletcher , Emma Broadfield , Sanjay Porwal , Cameron Knott , Catherine Boschert , Julie Smith , Angus Richardson , Dianne Hill , Graeme Duke , Peter Oziemski , Santiago Cegarra , Peter Chan , Deborah Welsh , Stephanie Hunter , Owen Roodenburg , John Dyett , Nicos Kokotsis , Max Moser , Yang Yang , Laven Padayachee , Joseph Vetro , Himangsu Gangopadhyay , Melissa Kaufman , Angaj Ghosh , Simone Said , Alpesh Patel , Shailesh Bihari , Elisha Matheson , Xia Jin , Tapaswi Shrestha , Kate Schwartz , Martin P Gallagher , Rosalba Cross , Winston Cheung , Helen Wong , Mark Kol , Asim Shah , Amanda Y Wang , Celia Bradford , Pierre Janin , Simon Finfer , Naomi Diel , Jonathan Gatward , Naomi Hammond , Anthony Delaney , Frances Bass , Elizabeth Yarad , Hergen Buscher , Claire Reynolds , Nerilee Baker , Michael Joannidis , Romuald Bellmann , Andreas Peer , Julia Hasslacher , Paul Koglberger , Sebastian Klein , Klemens Zotter , Anna Brandtner , Armin Finkenstedt , Adelheid Ditlbacher , Frank Hartig , Dietmar Fries , Mirjam Bachler , Bettina Schenk , Martin Wagner , Philipp Eller , Thomas Staudinger , Esther Tiller , Peter Schellongowski , Andja Bojic , Eric A Hoste , Stephanie Bracke , Luc De Crop , Daisy Vermeiren , Fernando Thome , Bianca Chiella , Lucia Fendt , Veronica Antunes , Jean-Philippe Lafrance , François Lamontagne , Frédérick d'Aragon , Charles St-Arnaud , Michael Mayette , Élaine Carbonnaeu , Joannie Marchand , Marie-Hélène Masse , Marilène Ladouceur , Alexis F Turgeon , François Lauzier , David Bellemare , Charles Langis Francoeur , Guillaume Leblanc , Gabrielle Guilbault , Stéphanie Grenier , Eve Cloutier , Annick Boivin , Charles Delisle-Thibault , Panagiota Giannakouros , Olivier Costerousse , Jean-François Cailhier , François-Martin Carrier , Ali Ghamraoui , Martine Lebrasseur , Fatna Benettaib , Maya Salamé , Dounia Boumahni , Ying Tung Sia , Jean-François Naud , Isabelle Roy , Braden J Manns , Shelley Duggan , Dominic Carney , Jennifer Barchard , Richard P Whitlock , Emilie Belley-Cote , Nevena Savija , Alexandra Sabev , Troy Campbell , Thais Creary , Kelson Devereaux , Shira Brodutch , Claudio Rigatto , Bojan Paunovic , Owen Mooney , Anna Glybina , Oksana Harasemiw , Michelle Di Nella , John Harmon , Navdeep Mehta , Louis Lakatos , Nicole Haslam , Francois Lellouche , Mathieu Simon , Ying Tung , Patricia Lizotte , Pierre-Alexandre Bourchard , Bram Rochwerg , Tim Karachi , Tina Millen , John Muscedere , David Maslove , J Gordon Boyd , Stephanie Sibley , John Drover , Miranda Hunt , Ilinca Georgescu , Randy Wax , Ilan Lenga , Kavita Sridhar , Andrew Steele , Kelly Fusco , Taneera Ghate , Michael Tolibas , Holly Robinson , Matthew A Weir , Ravi Taneja , Ian M Ball , Amit Garg , Eileen Campbell , Athena Ovsenek , Sean M Bagshaw , Sean Van Diepen , Nadia Baig , Sheldon Magder , Han Yao , Ahsan Alam , Josie Campisi , Erika Macintyre , Ella Rokosh , Kimberly Scherr , Stephen Lapinsky , Sangeeta Mehta , Sumesh Shah , Daniel J Niven , Henry T Stelfox , Stacey Ruddell , Michael Russell , Kym Jim , Gillian Brown , Kerry Oxtoby , Adam Hall , Luc Benoit , Colleen Sokolowski , Bhanu Prasad , Shelley Giebel , Demetrios J Kutsogiannis , Patricia Thompson , Tayne Thompson , Robert Cirone , Kanthi Kavikondala , Mark Soth , France Clarke , Alyson Takaoka , Ron Wald , David Mazer , Karen Burns , Jan Friedrich , David Klein , Gyan Sandhu , Marlene Santos , Imrana Khalid , Jennifer Hodder , Peter Dodek , Najib Ayas , Victoria Alcuaz , Gabriel Suen , Oleksa Rewa , Gurmeet Singh , Sean Norris , Neil Gibson , Castro Arias , Aysha Shami , Celine Pelletier , Neill K J Adhikari , Alireza Zahirieh , Andre Amaral , Nicole Marinoff , Navjot Kaur , Adic Perez , Jane Wang , Gregory Haljan , Christopher Condin , Lauralyn Mcintyre , Brigette Gomes , Rebecca Porteous , Irene Watpool , Swapnil Hiremath , Edward Clark , Margaret S Herridge , Felicity Backhouse , M Elizabeth Wilcox , Karolina Walczak , Vincent Ki , Asheer Sharman , Martin Romano , R T Noel Gibney , Adam S Romanovsky , Lorena Mccoshen , Gordon Wood , Daniel Ovakim , Fiona Auld , Gayle Carney , Meili Duan , Xiaojun Ji , Dongchen Guo , Zhili Qi , Jin Lin , Meng Zhang , Lei Dong , Jingfeng Liu , Pei Liu , Deyuan Zhi , Guoqiang Bai , Yu Qiu , Ziqi Yang , Jing Bai , Zhuang Liu , Haizhou Zhuang , Haiman Wang , Jian Li , Mengya Zhao , Xiao Zhou , Xianqing Shi , Baning Ye , Manli Liu , Jing Wu , Yongjian Fu , Dali Long , Yu Pan , Jinlong Wang , Huaxian Mei , Songsong Zhang , Mingxiang Wen , Enyu Yang , Sijie Mu , Jianquan Li , Tingting Hu , Bingyu Qin , Min Li , Cunzhen Wang , Xin Dong , Kaiwu Wang , Haibo Wang , Jianxu Yang , Bin Du , Chuanyao Wang , Dongxin Wang , Nan Li , Zhui Yu , Song Xu , Lan Yao , Guo Hou , Zhou Liu , Liping Lu , Yingtao Lian , Chunting Wang , Jichen Zhang , Ruiqi Ding , Guoqing Qi , Qizhi Wang , Peng Wang , Zhaoli Meng , Man Chen , Xiaobo Hu , Xiandi He , Shibing Zhao , Lele Hang , Rui Li , Suhui Qin , Kun Lu , Shijuan Dun , Cheng Liu , Qi Zhou , Zhenzhen Chen , Jing Mei , Minwei Zhang , Hao Xu , Jincan Lin , Qindong Shi , Lijuan Fu , Qinjing Zeng , Hongye Ma , Jinqi Yan , Lan Gao , Hongjuan Liu , Lei Zhang , Hao Li , Xiaona He , Jingqun Fan , Litao Guo , Yu Liu , Xue Wang , Jingjing Sun , Zhongmin Liu , Juan Yang , Lili Ding , Lulu Sheng , Xingang Liu , Jie Yan , Quihui Wang , Yifeng Wang , Dan Zhao , Shuangping Zhao , Chenghuan Hu , Jing Li , Fuxing Deng , Haibo Qui , Yi Yang , Min Mo , Chun Pan , Changde Wu , Yingzi Huang , Lili Huang , Airan Liu , Ville Pettilä , Suvi T Vaara , Anna-Maija Korhonen , Sanna Törnblom , Sari Sutinen , Leena Pettilä , Jonna Heinonen , Eliria Lappi , Taria Suhonen , Sari Karlsson , Sanna Hoppu , Ville Jalkanen , Anne Kuitunen , Markus Levoranta , Jaakko Långsjö , Sanna Ristimäki , Kaisa Malila , Anna Wootten , Simo Varila , Mikko J Järvisalo , Outi Inkinen , Satu Kentala , Keijo Leivo , Paivi Haltia , Didier Dreyfuss , Jean-Damien Ricard , Jonathan Messika , Abirami Tiagarajah , Malo Emery , Aline Dechanet , Coralie Gernez , Damien Roux , Laurent Martin-Lefevre , Maud Fiancette , Isabelle Vinatier , Jean Claude Lacherade , Gwenhaël Colin , Christine Lebert , Marie-Ange Azais , Aihem Yehia , Caroline Pouplet , Matthieu Henry-Lagarrigue , Amélie Seguin , Laura Crosby , Julien Maizel (1) , Dimitri Titeca-Beauport , Alexandre Demoule , Julien Mayaux , Martin Dres , Elise Morawiec , Maxens Decalvele , Suela Demiri , Morgane Faure , Clémence Marios , Maxime Mallet , Marie Amélie Ordon , Laura Morizot , Marie Cantien , François Pousset , Stéphane Gaudry , Florent Poirson , Yves Cohen , Laurent Argaud , Martin Cour , Laurent Bitker , Marie Simon , Romain Hernu , Thomas Baudry , Syvie de La Salle , Adrien Robine , Nicholas Sedillot , Xavier Tchenio , Camille Bouisse , Sylvie Roux , Saber Davide Barbar , Rémi Trusson , Fabienne Tamion , Steven Grangé , Dorothée Carpentier , Guillaume Chevrel , Luis Ensenyat-Martin , Sophie Marque , Jean-Pierre Quenot , Pascal Andreu , Auguste Dargent , Audrey Large , Nicolas Chudeau , Mickael Landais , Benoit Derrien , Jean Christophe Callahan , Christophe Guitton , Charlène Le Moal , Alain Robert , Karim Asehnoune , Raphaël Cinotti , Nicolas Grillot , Dominique Demeure , Christophe Vinsonneau , Imen Rahmani , Mehdi Marzouk , Thibault Dekeyser , Caroline Sejourne , Mélanie Verlay , Fabienne Thevenin , Lucie Delecolle , Didier Thevenin , Bertrand Souweine , Elisabeth Coupez , Mireille Adda , Jean-Pierre Eraldi , Antoine Marchalot , Nicolas De Prost , Armand Mekontso Dessap , Keyvan Razazi , Ferhat Meziani , Julie Boisrame-Helms , Raphael Clere-Jehl , Xavier Delabranche , Christine Kummerlen , Hamid Merdji , Alexandra Monnier , Yannick Rabouel , Hassene Rahmani , Hayat Allam , Samir Chenaf , Vincenta Franja , Bertrand Pons , Michel Carles , Frédéric Martino , Régine Richard , Benjamin Zuber , Guillaume Lacave , Karim Lakhal , Bertrand Rozec , Hoa Dang Van , Éric Boulet , Fouad Fadel , Cedric Cleophax , Nicolas Dufour , Caroline Grant , Marie Thuong , Jean Reignier , Emmanuel Canet , Laurent Nicolet , Thierry Boulain , Mai-Anh Nay , Dalila Benzekri , François Barbier , Anne Bretagnol , Toufik Kamel , Armelle Mathonnet , Grégoire Muller , Marie Skarzynski , Julie Rossi , Amandine Pradet , Sandra Dos Santos , Aurore Guery , Lucie Muller , Luis Felix , Julien Bohé , Guillaume Thiéry , Nadia Aissaoui , Damien Vimpere , Morgane Commeureuc , Jean-Luc Diehl , Emmanuel Guerot , Alain Combes , Ania Nieszkowska , Paul Masi , Orfeas Liangos , Monika Wittig , Alexander Zarbock , Mira Küllmar , Thomas Van Waegeningh , Nadine Rosenow , Alistair D Nichol , Kathy Brickell , Peter Doran , Patrick T Murray , Giovanni Landoni , Rosalba Lembo , Alberto Zangrillo , Giacomo Monti , Margherita Tozzi , Matteo Marzaroli , Gaetano Lombardi , Gianluca Paternoster , Michelangelo Vitiello , Shay Mcguinness , Rachael Parke , Magdalena Butler , Eileen Gilder , Keri-Anne Cowdrey , Samantha Wallace , Jane Hallion , Melissa Woolett , Philippa Neal , Karina Duffy , Stephanie Long , Colin Mcarthur , Catherine Simmonds , Yan Chen , Rachael Mcconnochie , Lynette Newby , David Knight , Seton Henderson , Jan Mehrtens , Stacey Morgan , Anna Morris , Kymbalee Vander Hayden , Tara Burke , Matthew Bailey , Ross Freebairn , Lesley Chadwick , Penelope Park , Christine Rolls , Liz Thomas , Ulrike Buehner , Erin Williams , Jonathan Albrett , Simon Kirkham , Carolyn Jackson , Troy Browne , Jennifer Goodson , David Jackson , James Houghton , Owen Callender , Vicki Higson , Owen Keet , Clive Dominy , Paul Young , Anna Hunt , Harriet Judd , Cassie Lawrence , Shaanti Olatunji , Yvonne Robertson , Charlotte Latimer-Bell , Deborah Hendry , Agnes Mckay-Vucago , Nina Beehre , Eden Lesona , Leanlove Navarra , Chelsea Robinson , Ryan Jang , Andrea Junge , Bridget Lambert , Antoine G Schneider , Michel Thibault , Philippe Eckert , Sébastien Kissling , Erietta Polychronopoulos , Elettra Poli , Marco Altarelli , Madeleine Schnorf , Samia Abed Mallaird , Claudia Heidegger , Aurelie Perret , Philippe Montillier , Frederic Sangla , Seigenthaller Neils , Aude De Watteville , Mandeep-Kaur Phull , Aparna George , Nauman Hussain , Tatiana Pogreban , Steve Lobaz , Alison Daniels , Mishell Cunningham , Deborah Kerr , Alice Nicholson , Pradeep Shanmugasundaram , Judith Abrams , Katarina Manso , Geraldine Hambrook , Elizabeth Mckerrow , Juvy Salva , Stephen Foulkes , Matthew Wise , Matt Morgan , Jenny Brooks , Jade Cole , Tracy Michelle Davies , Helen Hill , Emma Thomas , Marcela Vizcaychipi , Behrad Baharlo , Jaime Carungcong , Patricia Costa , Laura Martins , Ritoo Kapoor , Tracy Hazelton , Angela Moon , Janine Musselwhite , Ben Shelley , Philip Mccall , Marlies Ostermann , Gill Arbane , Aneta Bociek , Martina Marotti , Rosario Lim , Sara Campos , Neus Grau Novellas , Armando Cennamo , Andrew Slack , Duncan Wyncoll , Luigi Camporota , Simon Sparkes , Rosalinde Tilley , Austin Rattray , Gayle Moreland , Jane Duffy , Elizabeth Mcgonigal , Philip Hopkins , Clare Finney , John Smith , Harriet Noble , Hayley Watson , Claire-Louise Harris , Emma Clarey , Eleanor Corcoran , James Beck , Clare Howcroft , Nora Youngs , Elizabeth Wilby , Bethan Ogg , Adam Wolverson , Sandra Lee , Susie Butler , Maryanne Okubanjo , Julia Hindle , Ingeborg Welters , Karen Williams , Emily Johnson , Julie Patrick-Heselton , David Shaw , Victoria Waugh , Richard Stewart , Esther Mwaura , Lynn Wren , Louise Mew , Sara-Beth Sutherland , Jane Adderley , Jim Ruddy , Margaret Harkins , Callum Kaye , Teresa Scott , Wendy Mitchell , Felicity Anderson , Fiona Willox , Vijay Jagannathan , Michele Clark , Sarah Purv , Andrew Sharman , Megan Meredith , Lucy Ryan , Louise Conner , Cecilia Peters , Dan Harvey , Ashraf Roshdy , Amy Collins , Malcolm Sim , Steven Henderson , Nigel Chee , Sally Pitts , Katie Bowman , Maria Dilawershah , Luke Vamplew , Elizabeth Howe , Paula Rogers , Clara Hernandez , Clara Prendergast , Jane Benton , Alex Rosenberg , Lui G Forni , Alice Grant , Paula Carvelli , Ajay Raithatha , Sarah Bird , Max Richardson , Matthew Needham , Claire Hirst , Jonathan Ball , Susannah Leaver , Luisa Howlett , Carlos Castro Delgado , Sarah Farnell-Ward , Helen Farrah , Geraldine Gray , Gipsy Joseph , Francesca Robinson , Ascanio Tridente , Clare Harrop , Karen Shuker , Derek Mclaughlan , Judith Ramsey , Sharon Meehan , Bernd Oliver Rose , Rosie Reece-Anthony , Babita Gurung , Tony Whitehouse , Catherine Snelson , Tonny Veenith , Andy Johnston , Lauren Cooper , Ron Carrera , Karen Ellis , Emma Fellows , Samanth Harkett , Colin Bergin , Elaine Spruce , Liesl Despy , Stephanie Goundry , Natalie Dooley , Tracy Mason , Amy Clark , Gemma Dignam , Geraldine Ward , Ben Attwood , Penny Parsons , Sophie Mason , Michael Margarson , Jenny Lord , Philip Mcglone , Luke E Hodgson , Indra Chadbourn , Raquel Gomez , Jordi Margalef , Rinus Pretorius , Alexandra Hamshere , Joseph Carter , Hazel Cahill , Lia Grainger , Kate Howard , Greg Forshaw , Zoe Guy , Kianoush B Kashani , Robert C Albright Jr , Amy Amsbaugh , Anita Stoltenberg , Alexander S Niven , Matthew Lynch , Annmarie O'Mara , Syed Naeem , Sairah Sharif , Joyce Mckenney Goulart , Ashita Tolwani , Claretha Lyas , Laura Latta , Azra Bihorac , Haleh Hashemighouchani , Philip Efron , Matthew Ruppert , Julie Cupka , Sean Kiley , Joshua Carson , Peggy White , George Omalay , Sherry Brown , Laura Velez , Alina Marceron , Javier A Neyra , Juan Carlos Aycinena , Madona Elias , Victor M Ortiz-Soriano , Caroline Hauschild , Robert Dorfman

1 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517

Background: Acute kidney injury is common in critically ill patients, many of whom receive renal-replacement therapy. However, the most effective timing for the initiation of such therapy remains uncertain. Methods: We conducted a multinational, randomized, controlled trial involving critically ill patients with severe acute kidney injury. Patients were randomly assigned to receive an accelerated strategy of renal-replacement therapy (in which therapy was initiated within 12 hours after the patient had met eligibility criteria) or a standard strategy (in which renal-replacement therapy was discouraged unless conventional indications developed or acute kidney injury persisted for >72 hours). The primary outcome was death from any cause at 90 days. Results: Of the 3019 patients who had undergone randomization, 2927 (97.0%) were included in the modified intention-to-treat analysis (1465 in the accelerated-strategy group and 1462 in the standard-strategy group). Of these patients, renal-replacement therapy was performed in 1418 (96.8%) in the accelerated-strategy group and in 903 (61.8%) in the standard-strategy group. At 90 days, death had occurred in 643 patients (43.9%) in the accelerated-strategy group and in 639 (43.7%) in the standard-strategy group (relative risk, 1.00; 95% confidence interval [CI], 0.93 to 1.09; P = 0.92). Among survivors at 90 days, continued dependence on renal-replacement therapy was confirmed in 85 of 814 patients (10.4%) in the accelerated-strategy group and in 49 of 815 patients (6.0%) in the standard-strategy group (relative risk, 1.74; 95% CI, 1.24 to 2.43). Adverse events occurred in 346 of 1503 patients (23.0%) in the accelerated-strategy group and in 245 of 1489 patients (16.5%) in the standard-strategy group (P<0.001). Conclusions: Among critically ill patients with acute kidney injury, an accelerated renal-replacement strategy was not associated with a lower risk of death at 90 days than a standard strategy. (Funded by the Canadian Institutes of Health Research and others; STARRT-AKI ClinicalTrials.gov number, NCT02568722.).

Mots clés: Acute Kidney Injury; Renal-Replacement Therapy

Domaines: Sciences du Vivant [q-bio]

Sean M Bagshaw, Ron Wald, Neill K J Adhikari, Rinaldo Bellomo, Bruno R Da Costa, et al.. Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury. New England Journal of Medicine, 2020, 383 (3), pp.240-251. ⟨10.1056/NEJMoa2000741⟩. ⟨hal-03922053⟩