Nephro Trial Files Throwback Thursday: Early vs. Late RRT in Severe AKI in ICU, Early vs. Late Dialysis in CKD, and Cinacalcet in ESRD
Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit
Gaudry S et al. NEJM (July 2016)
Bottom Line: This multicenter randomized trial aimed to compare the effects of an early versus delayed strategy for renal-replacement therapy in critically ill patients with severe acute kidney injury. The study included 620 patients and the primary outcome was overall survival at day 60. Results showed no significant difference in mortality between the two strategies, but a delayed strategy may prevent the need for renal-replacement therapy in some patients. The delayed strategy also had a lower rate of catheter-related bloodstream infections and improved kidney function. This study provides evidence for the use of a delayed strategy in this patient population.
A Randomized, Controlled Trial of Early versus Late Initiation of Dialysis
Cooper BA et al. NEJM (August 2010)
Bottom Line: This study was a randomized controlled trial conducted at 32 centers in Australia and New Zealand to determine if the timing of initiation of maintenance dialysis affects survival in patients with stage V chronic kidney disease. A total of 828 adults were randomly assigned to either an early-start group (initiation of dialysis when estimated GFR was 10.0 to 14.0 ml per minute) or a late-start group (initiation of dialysis when estimated GFR was 5.0 to 7.0 ml per minute). The primary outcome was death from any cause, and the results showed no significant difference in survival between the two groups. There were also no significant differences in adverse events between the groups. Therefore, the study concluded that planned early initiation of dialysis did not improve survival or clinical outcomes in this patient population.
Effect of Cinacalcet on Cardiovascular Disease in Patients Undergoing Dialysis
EVOLVE Trial Investigators. NEJM (December 2012)
Bottom Line: This randomized clinical trial investigated the use of cinacalcet, a calcimimetic agent, in reducing the risk of death or nonfatal cardiovascular events in patients with moderate-to-severe secondary hyperparathyroidism undergoing hemodialysis. The study included 3883 patients and compared the intervention group receiving cinacalcet to the comparator group receiving placebo. After a median follow-up of 21.2 months, there was no significant difference in the primary composite endpoint between the two groups. However, the cinacalcet group did experience higher rates of hypocalcemia and gastrointestinal adverse events. The study concluded that cinacalcet did not significantly reduce the risk of death or major cardiovascular events in this patient population.
Nephro Trial Files Issue #NPH-2024-05
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