Why ELAIN and AKIKI Should Not Be Compared: Resolving Discordant Studies

Dreyfuss, Didier; Hajage, David; Gaudry, Stéphane

doi:10.1053/j.ajkd.2017.02.370

Cited by 8 publications

(8 citation statements)

References 6 publications

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“…We disagree with the comparison between the AKIKI (Artificial Kidney Initiation in Kidney Injury) trial 1…”

Section: Why Elain and Akiki Should Not Be Compared: Resolving Discormentioning

confidence: 91%

“…Swapnil Hiremath, MD, MPH, 1 David S. Goldfarb, MD 2,3 David N. Juurlink, MD, PhD 4 We are grateful for the opportunity to respond to Hiremath et al 1 Our clinical guide presents a framework on managing pain in patients with kidney disease for practitioners to reference while using their judgment when prescribing medications. 2 Our caution regarding NSAID use is intended as guidance rather than an absolute contraindication.…”

Section: Opioid Overuse or Nsaid Underuse? A Response To The Pain Guidementioning

confidence: 99%

See 1 more Smart Citation

In Reply to ‘Why ELAIN and AKIKI Should Not Be Compared: Resolving Discordant Studies’

Wald

Gallagher²,

Bagshaw

2017

American Journal of Kidney Diseases

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“…We disagree with the comparison between the AKIKI (Artificial Kidney Initiation in Kidney Injury) trial 1…”

Section: Why Elain and Akiki Should Not Be Compared: Resolving Discormentioning

confidence: 91%

Section: Opioid Overuse or Nsaid Underuse? A Response To The Pain Guidementioning

confidence: 99%

In Reply to ‘Why ELAIN and AKIKI Should Not Be Compared: Resolving Discordant Studies’

Wald

Gallagher²,

Bagshaw

2017

American Journal of Kidney Diseases

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“…Both studies were intention‐to‐treat and thus also included in the analysis patients who were randomized but had no need to be started on RRT. However, these studies were very different in their approach . The ELAIN study included patients with predominantly postsurgical KDIGO stage 2 AKI and either septic shock or refractory fluid overload.…”

Section: Trials On Early Vs Late Start Of Rrtmentioning

confidence: 99%

“…However, these studies were very different in their approach. 46 RRT. This is no surprise, as almost 75% of patients were diagnosed with fluid overload or worsening pulmonary edema and had thus in fact a "hard" indication to start RRT already before randomization.…”

Section: Parameter Definitionmentioning

confidence: 99%

Haste makes waste—Should current guideline recommendations for initiation of renal replacement therapy for acute kidney injury be changed?

Vanmassenhove

Vanholder

Biesen

et al. 2018

Seminars in Dialysis

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There is broad consensus among guideline organizations that renal replacement therapy (RRT) should not be delayed in case of life-threatening conditions. However, in case of severe acute kidney injury (AKI) without these conditions, it is unclear whether immediate RRT has an advantage over delayed RRT. Two recently published randomized controlled trials (AKIKI and ELAIN) with seemingly opposite results have reignited the discussion whether guideline recommendations on initiation strategies in severe AKI should be adapted. This editorial discusses RRT initiation strategies in severe AKI, based on recent literature and highlights the potential advantages and disadvantages of immediate vs delayed start. Overall, evidence in favor of immediate compared to delayed strategies is sparse and there is wide heterogeneity across studies making it difficult to draw firm conclusions. RRT should not be delayed in case of refractory hyperkalemia, severe metabolic acidosis or pulmonary edema resistant to diuretics. In all other cases, a delayed strategy seems justified and might enhance renal recovery. RRT is not a "it doesn't hurt to try" technique and can expose the patient to a higher risk of bleeding, hemodynamic problems, under-dosing of antibiotics, loss of nutrients, catheter-related complications and the uncertain effects of blood-membrane interactions. There is no compelling reason to change current guideline recommendations and research focus should shift toward the development of algorithms as a decision aid tool for RRT initiation in severe AKI.

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“…We are grateful for the opportunity to respond to Hiremath et al 1 Our clinical guide presents a framework on managing pain in patients with kidney disease for practitioners to reference while using their judgment when prescribing medications. 2 Our caution regarding NSAID use is intended as guidance rather than an absolute contraindication.…”

mentioning

confidence: 99%