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Hajage, F Schortgen,
L.M.Lefevre, B. Pons, E. Boulet, et al
DOI: 10.1056/NEJMoa1603017
INCLUSION CRITERIA:
Severe acute kidney injury (Kidney Disease: Improving
Global Outcomes [KDIGO] classification stage 3)
Adults (18 years of age or older)
Admitted to the intensive care unit
Acute kidney injury that was compatible with a diagnosis
of acute tubular necrosis in the context of ischemic or
toxic injury
Receiving invasive mechanical ventilation, catecholamine
infusion (epinephrine or norepinephrine), or both
Did not have a potentially life-threatening complication
directly related to renal failure to either an early or a
delayed strategy of renal-replacement therapy
METHODS:
Patients
EXCLUSION CRITERIA
The following severe laboratory :
A blood urea nitrogen level > 112 mg /dl
(40 mmol /L)
A serum potassium concentration > 6 mmol/L or
> 5.5 mmol/L despite medical treatment
A pH below 7.15 (PaCO2 < 35 mmHg or PaCO2 > 50
mmHg without increasing alveolar ventilation
Acute pulmonary edema due to fluid overload
These criteria were later used to establish the
indication for renal-replacement therapy in
patients assigned to the delayed strategy
METHODS:
Randomization
Primary outcome :
150 (48,5) 153 (49,7) 1,03 (0,82-1,29) 0,79
Death Day 60
Although, mortality did not differ significantly between the two study
groups. Careful surveillance is mandatory when deciding to delay renal-
replacement therapy in patients with severe acute kidney injury so that
any complication will be detected and renal-replacement therapy
initiated without delay. In the trial, delaying the initiation of therapy
allowed many patients to recover from acute kidney injury without
embarking on such a treatment course.
3. Are the valid important results of this individual study
applicable to our patient?
a. Is our patient so different from those in the study that
its results cannot apply? No, its not.
b. Is the treatment feasible in our setting? Yes, it is.
c. What are our patients potential benefits and harms
from the therapy? The potential benefits and harms are
similar as this study group
d. Will the potential benefits of treatment outweigh the
potential harms of treatment for our patient? Yes, they
will.