A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure

Mehta, Ravindra L.; McDonald, Brian R.; Gabbai, Francis B.; Pahl, Madeleine V.; Pascual, M.T.; Farkas, Arthur J.; Kaplan, Robert M.

doi:10.1046/j.1523-1755.2001.0600031154.x

Cited by 572 publications

(361 citation statements)

References 24 publications

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“…A total of 15 studies were examined; “in‐hospital mortality” was assessed based on seven RCTs264, 265, 266, 267, 268, 269, 270 and yielded a risk ratio of 1.01 (95% CI: 0.92–1.12); “transition to chronic dialysis” was examined based on three RCTs264, 266, 269 and yielded a risk ratio of 1.01 (95% CI: 0.92–1.07); no difference was observed between apheresis performed continuously and intermittently. Three RCTs269, 270, 271 were also examined with respect to reduction in blood pressure, and no differences in the risk ratio of 0.92 (95% CI: 0.72–1.16) were observed in the studies.…”

Section: Cq12: Acute Kidney Injury/blood Apheresismentioning

confidence: 99%

“…Three RCTs269, 270, 271 were also examined with respect to reduction in blood pressure, and no differences in the risk ratio of 0.92 (95% CI: 0.72–1.16) were observed in the studies. However, the two RCTs266, 268 extracted from the systematic review followed protocols that excluded cases involving patients with unstable hemodynamics. Continuous blood apheresis is already recognized as a standard treatment in such cases, and no RCT conducted to date has compared continuous and intermittent apheresis.…”

Section: Cq12: Acute Kidney Injury/blood Apheresismentioning

confidence: 99%

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Section: Cq12: Acute Kidney Injury/blood Apheresismentioning

confidence: 99%

Section: Cq12: Acute Kidney Injury/blood Apheresismentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

View full text Add to dashboard Cite

show abstract

“…Details of the study's inclusion and exclusion criteria are available elsewhere (25). Two hundred and forty additional patients (28.2%) required some form of dialysis during their ICU stay; 147 (17.3%) received IHD, and 93 (10.9%) CRRT.…”

Section: Patientsmentioning

confidence: 99%

“…Among these 851, 166 patients were entered into a randomized clinical trial comparing intermittent hemodialysis (IHD) with continuous renal replacement therapy (CRRT), the results of which are reported elsewhere (25). Incorporating all patients who were followed over the study period, we accumulated a vast array of demographic, clinical, and laboratory data from which a severity of illness index could be developed.…”

mentioning

confidence: 99%

Refining Predictive Models in Critically Ill Patients with Acute Renal Failure

Mehta

Pascual²,

Gruta³

et al. 2002

Journal of the American Society of Nephrology

Self Cite

323

211

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Abstract. Mortality rates in acute renal failure remain extremely high, and risk-adjustment tools are needed for quality improvement initiatives and design (stratification) and analysis of clinical trials. A total of 605 patients with acute renal failure in the intensive care unit during 1989-1995 were evaluated, and demographic, historical, laboratory, and physiologic variables were linked with in-hospital death rates using multivariable logistic regression. Three hundred and fourteen (51.9%) patients died in-hospital. The following variables were significantly associated with in-hospital death: age (odds ratio [OR], 1.02 per yr), male gender (OR, 2.36), respiratory (OR, 2.62), liver (OR, 3.06), and hematologic failure (OR, 3.40), creatinine (OR, 0.71 per mg/dl), blood urea nitrogen (OR, 1.02 per mg/dl), log urine output (OR, 0.64 per log ml/d), and heart rate (OR, 1.01 per beat/min). The area under the receiver operating characteristic curve was 0.83, indicating good model discrimination. The model was superior in all performance metrics to six generic and four acute renal failurespecific predictive models. A disease-specific severity of illness equation was developed using routinely available and specific clinical variables. Cross-validation of the model and additional bedside experience will be needed before it can be effectively applied across centers, particularly in the context of clinical trials.Acute renal failure (ARF) in critically ill patients is associated with a distressingly high mortality rate (1-3). Despite improvements in intensive care and dialytic technology, particularly with continuous renal replacement therapies, we have not observed meaningful improvements in patient survival over the past three decades (4 -8). In most series, more than 50% of patients with hospital-acquired ARF die before hospital discharge; of those who survive, between 10 and 33% require long-term dialysis (9 -11).Over the past decade, several clinical trials have been conducted, aiming to reduce ARF-associated mortality (12)(13)(14). Most of these studies have unfortunately proved unsuccessful, including relatively large, well-designed trials using pharmacologic agents with strong preclinical data (e.g., atrial natriuretic peptide [ANP]). Among the difficulties in design and analysis of clinical trials in ARF are the lack of a standardized definition of ARF, the heterogeneity of ARF, comorbidity and severity of illness directly influencing mortality, and large variations in the process of care. -24). Moreover, the timing of evaluation (e.g., consultation, initial dialysis procedure) and the population to which the index was applied (e.g., all patients with ARF, only dialyzed patients, etc.) have differed across studies. To prepare for future clinical trials in ARF, it is essential that valid, generalizable models for risk adjustment be developed, both for stratification in patient selection and for covariate adjustment in the event of imbalanced randomization.We evaluated 851 consecutive cases of ARF in the intensive...

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“…Besides, it is possible that the increased use of well-defined strategies of first care to trauma patients, such as Advanced Trauma Life Support -ATLS -, has allowed a higher rate of initial survival, thus increasing the seriousness of the patients' diseases at the ITUs (25,27) .…”

Section: Discussionmentioning

confidence: 99%

Pacientes vítimas de politrauma com insuficiência renal aguda na unidade de terapia intensiva

et al. 2008

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Objective: To identify the characteristics of patients with acute renal failure (ARF), polytrauma victims hospitalized in an Intensive Care Unit (ICU). Methods: A retrospective analysis was performed on 357 records of patients with ARF in the period of 2002 to 2003. These patients presented a creatinine index of 1.8 to 4 mg/dl. Of these patients, 10.6% in the ICU were polytrauma victims. Results: Of the 38 (10.6%) patients with ARF and polytrauma victims, 78.9% of were males; 47.3% were aged between 16 and 45 years; 84.3% presented oliguria; 92.1% received no treatment for ARF during hospitalization; 50% remained from one to five days in the ICU; 47.3% had not presented any underlying disease and mortality occurred in 50%. Conclusion: Daily control of the renal function in polytrauma victims is important to prevent ARF complications and consequent mortality. Resultados: Dos 38 (10,6%) pacientes portadores de IRA e vítimas de politrauma, 78,9% eram do sexo masculino; 47,3% tinham idade entre 16 e 45 anos; 84,3% apresentaram oligúria; 92,1% não receberam tratamento para IRA durante a internação; 50% permaneceram de um a cinco dias internados na UTI; 47,3% não apresentaram nenhuma doença de base e a mortalidade ocorreu em 50% desta amostra. Conclusão: Concluiu-se que a monitorização diária da função renal das vítimas de politrauma é um cuidado importante para evitar as complicações da IRA e a respectiva mortalidade. Descritores: Insuficiência renal aguda; Unidades de terapia intensiva; Traumatismo múltiplo RESUMEN Objetivos: Identificar las características de pacientes portadores de insuficiencia renal aguda (IRA), víctimas de politrauma, internados en una unidad de cuidados intensivos (UCI). Métodos: Se llevó a cabo un análisis retrospectivo de 357 historias clínicas de portadores de IRA, en el período de 2002 a 2003, con creatinina sérica de 1,8 a 4 mg/dl. De estos pacientes internados en la UCI, el 10,6% eram víctimas de politrauma. Resultados: De los 38 (10,6%) pacientes portadores de IRA y víctimas de politrauma, el 78,9% eran del sexo masculino; el 47,3% tenían edades entre 16 y 45 años; el 84,3% presentaron oliguria; el 92,1% no recibieron tratamiento para IRA durante el internamiento; el 50% permanecieron de uno a cinco días internados en la UCI; el 47,3% no presentaron ninguna enfermedad de base y la mortalidad ocurrió en el 50% de esta muestra. Conclusión: el monitoreo diario de la función renal de las víctimas de politrauma es un cuidado importante para evitar las complicaciones de la IRA y la respectiva mortalidad.

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A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure

Cited by 572 publications

References 24 publications

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Refining Predictive Models in Critically Ill Patients with Acute Renal Failure

Pacientes vítimas de politrauma com insuficiência renal aguda na unidade de terapia intensiva

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