There’s no misunderstanding this fact: renal-replacement therapy is effective for patients with severe acute kidney injuries (AKI). However, states Kenny Walter in MD Magazine, the efficacy of this treatment can depend on when it is given. But researchers weren’t sure at what stage renal-replacement therapy should be started and at which stage it failed to improve patient outcomes. In a multinational trial, researchers determined how and when to best administer this treatment. You can read the full results in the New England Journal of Medicine.
Acute Kidney Injury (AKI)
Also known as acute renal failure, acute kidney injury (AKI) is common in critically ill patients and older individuals, particularly those who are hospitalized. According to the National Kidney Foundation, AKI:
is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days. AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your body.
In addition to the kidneys, this condition can also affect the brain, heart, lungs, and other organs. Symptoms differ based on cause and organs affected, but can include:
- Nausea and vomiting
- Shortness of breath
- Chest pain
- Swelling of the lower extremities
- Low urine output
Learn more about AKI here.
Within the study, researchers sought to determine the efficacy of accelerated renal-replacement therapy. 3,019 patients participated in the randomized study. Of these, 1,418 received accelerated therapy, and 903 received “standard” therapy. Other patients were studied as well; however, these were the numbers ultimately associated with treatment.
How do these differ, you might ask? Standard therapy refers to not administering renal-replacement therapy unless AKI lasted for over 72 hours (3 days). However, accelerated renal-replacement therapy administers the therapy within 12 hours of patient eligibility.
After a 3-month period, researchers found the following:
- 643 patients who received accelerated renal-replacement therapy died.
- 639 patients who received standard treatment died.
- 85 patients from the accelerated group, and 49 from the standard group, still relied on renal-replacement therapy.
- 346 patients who received accelerated therapy experienced adverse reactions, compared to 245 patients receiving standard treatment.
As a result, researchers determined that accelerated renal-replacement therapy is not more effective in treating AKI than standard therapy. This data also adds to an understanding of AKI and renal function. In a prior study, researchers determined that tracking proteinuria in patients with AKI can predict disease progression. After analyzing data from 1,538 patients, researchers found that higher urine albumin-to-creatinine ratio (ACR) raised the risk of kidney disease progression. Now, researchers can combine this data with prior data to better track and treat patients with AKI.