Nephro Trial Files Throwback Thursday: Early vs. Delayed RRT in Septic Shock, Benazepril in Non-Diabetic CKD, and Immunosuppression after Kidney Transplant
Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis
Barbar SD et al. NEJM (October 2018)
Bottom Line: This multicenter, randomized, controlled trial aimed to determine the ideal time for initiation of renal-replacement therapy in patients with early-stage septic shock and severe acute kidney injury. The study was stopped early for futility after the second planned interim analysis. A total of 488 patients were randomized to receive either early or delayed initiation of renal-replacement therapy. The primary outcome of death at 90 days showed no significant difference between the two groups. There were also no significant differences in life-threatening complications related to acute kidney injury. Overall, the study concluded that there was no significant difference in mortality at 90 days between patients who received early or delayed initiation of renal-replacement therapy.
Efficacy and Safety of Benazepril for Advanced Chronic Renal Insufficiency
Hou FF et al. NEJM (January 2006)
Bottom Line: This is a randomized, double-blind study with a sample size of 422 patients without diabetes who had advanced renal insufficiency. The study lasted for a mean of 3.4 years and compared the efficacy and safety of benazepril to placebo in reducing the risk of a doubling of serum creatinine level, end-stage renal disease, or death. The results showed that benazepril was associated with a 43% reduction in the risk of the primary end point and a 52% reduction in proteinuria levels. The study also found a 23% reduction in the rate of decline in renal function with benazepril therapy. Overall, benazepril was found to confer substantial renal benefits in this patient population.
Reduced Exposure to Calcineurin Inhibitors in Renal Transplantation
Ekberg H et al. NEJM (December 2007)
Bottom Line: This is a randomized clinical trial with a sample size of 1645 renal-transplant recipients. The study evaluated the efficacy and relative toxic effects of four immunosuppressive regimens. The study duration is not specified. The study is not blinded. The patient population is renal-transplant recipients. The comparison groups are daclizumab, mycophenolate mofetil, and corticosteroids in combination with low-dose tacrolimus, standard-dose cyclosporine, low-dose cyclosporine, and low-dose sirolimus. The primary outcome is the estimated GFR 12 months after transplantation, with a mean calculated GFR of 65.4 ml per minute in the low-dose tacrolimus group. The safety outcome results showed a higher incidence of serious adverse events in the low-dose sirolimus group. The conclusion is that the daclizumab, mycophenolate mofetil, and corticosteroids regimen with low-dose tacrolimus may be advantageous for renal function, allograft survival, and acute rejection rates.
Nephro Trial Files Issue #NPH-2024-07
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