Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit

Gaudry, Stéphane; Hajage, David; Schortgen, Frédérique; Martin-Lefèvre, Laurent; Pons, Bertrand; Boulet, Éric; Boyer, Alexandre; Chevrel, Guillaume; Lerolle, Nicolas; Carpentier, Dorothée; Prost, Nicolas de; Lautrette, Alexandre; Bretagnol, Anne; Mayaux, Julien; Nseir, Saad; Mégarbane, Bruno; Thirion, Marina; Forel, Jean-Marie; Maizel, Julien; Yonis, Hodane; Markowicz, Philippe; Thiéry, Guillaume; Tubach, Florence; Ricard, Jean‐Damien; Dreyfuss, Didier

doi:10.1056/nejmoa1603017

Cited by 905 publications

(894 citation statements)

References 40 publications

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“…Three RCTs258, 259, 260 were used to perform the new meta‐analysis. In the results, the impact of early‐stage initiation of blood apheresis on 28‐day or 30‐day mortality was a risk ratio of 0.83 (95% confidence interval [CI]: 0.64–1.09), and a risk ratio of 0.51 for the rate of dialysis dependence on day 60 (95% CI: 0.25–1.06).…”

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

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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%

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

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“…Die deutsche ELAIN-Studie ("early versus late initiation of renal replacement therapy in critically ill patients"; [36]) und die französische AKI-KI-Studie ("the artificial kidney initiation in kidney injury"; [6]) untersuchten diese Fragestellung. Bei ELAIN handelt es sich um eine monozentrische Studie anhauptsächlich herzchirurgischen postoperativen Patienten (n = 231).…”

Section: Beginn Der Nierenersatztherapieunclassified

Nierenersatztherapie im akuten Nierenversagen

Klein

Joannidis

2017

Med Klin Intensivmed Notfmed

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Nierenersatztherapie im akuten NierenversagenTrotz weltweiter Forschungsbemühun-gen in den letzten Jahren zählt das akute Nierenversagen (ANV) bzw. die akute Nierenschädigung ("acute kidney injury", AKI) unverändert zu einer der Komplikationen auf Intensivstationen, die mit hoher Morbidität und Mortalität einhergehen. Im Rahmen der multinationalen AKI-EPI-Studie wurde bei 57,3 % (95 %-Konfidenzintervall [KI] 55,0-29,6) der Intensivpatienten ein ANV festgestellt [7]. Andere Studien gaben bei diesem Patientenkollektiv eine Inzidenz des ANV von 20-50 % an [4,24]. Weltweit sind 13,3 Mio. Menschen jedes Jahr von einem ANV betroffen und es wird angenommen, dass hierdurch jährlich 1,7 Mio. Todesfälle verursacht werden [15]. Die derzeit aktuellste Version der Behandlungsempfehlungen des ANV stellen die Kidney-Disease-Improving-GlobalOutcomes(KDIGO)-Leitlinien aus dem Jahr 2012 dar. Auf diesen basiert auch die derzeit allgemein gültige Einteilung der Stadien des ANV. Eine Zunahme der Mortalität kann bei steigendem Schweregrad der Nierenschädigung beobachtet werden (KDIGO 1 -Odds-Ratio, OR: 2,19; 95%-KI: 1, 35;18;04;[7]). Im Durchschnitt benötigen 5-13 % der Intensivpatienten eine Nierenersatztherapie, das entspricht etwa 25 % der Patienten mit ANV [7,19,30].

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“…These trials immediately revived the heated debate on when to start renal replacement therapy. In the study of Gaudry et al (9) patients did not show a survival benefit at day 60, whereas Zarbock et al (10) demonstrated a significantly reduced 90-day all-cause mortality with early initiation of renal replacement therapy. How is it that two studies addressing exactly the same problem reach such opposing conclusions?…”

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confidence: 95%