Thread by @jadav_md

My maiden attempt at Tweetorial-- 💥on STARRT-AKI trial. @NephJC @kidney_boy @Nephro_Sparks @ssfarouk @STARRTAKI @hswapnil
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💥Background:
⚡️AKI is associated with high risk of death in ICU
⚡️Initiation of dialysis early has conceivable advantages
⚡️Appropriate timing for dialysis is uncertain
⚡️Previous studies👇 have shown discrepant results

💥Previous studies:
⚡️nejm.org/doi/full/10.10…
⚡️nejm.org/doi/full/10.10…
⚡️kidney-international.org/article/S2157-…
⚡️jamanetwork.com/journals/jama/…
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💥Methods:
⚡️168 hospitals in 15 countries
⚡️Eligibility: 18+ yrs, admitted to ICU & AKI; KDIGO 2 or 3
⚡️Exclusion: Emergency dialysis, Advanced CKD, previous h/o dialysis, unusual cause of AKI
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💥Randomization--> assigned in a 1:1 ratio to following👇
⚡️Either accelerated initiation dialysis (starting ASAP or within 12 hours of eligibility)
⚡️Or initiation of dialysis with standard indications: K > 6, pH < 7.2, volume overload, severe respiratory failure
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💥Outcomes
⚡️Primary: death from any cause--at 90 days
⚡️Secondary: dialysis dependence, composite of death or dialysis dependence, or sustained ⬇️kidney function--at 90 days.
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💥Adverse events: related to dialysis and vascular access were reported through 14 days among ALL patients.
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💥Statistical analysis:
⚡️modified intention-to-treat principle
⚡️primary outcome death@ 90 days using chi-square test
⚡️adjusted logistic regression analysis
⚡️kaplan-Meier time-to-event analysis
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💥Results: from oct 2015 - sept 2019, a total of 11852 pts met provisional eligibility as follows👇
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💥Baseline characteristics were well balanced in both the groups. 👇
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💥Primary outcome: death at 90 days --> 43.9% in accelerated grp as compared to 43.7% in std grp
RR 1.0(0.93-1.09)
💥Secondary outcome: no significant diff between 2 grps except dialysis dependence at 90 days⚡️higher in accelerated 10.4% vs 6% in std grp. RR 1.74 (1.2-2.4)
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💥Summary 👇
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💥Limitations:
⚡️individual clinical bias
⚡️introduction of patient heterogeneity with judgement of individual clinician on patients' eligibility
⚡️adverse events occurred more in accelerated group
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💥Strengths:
⚡️large sample size
⚡️wide spectrum of ICUs around the world ensuring broad generalization
⚡️clinical equipoise to guide eligibility
⚡️decision on initiation of dialysis for enrolled pts was genuinely uncertain
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💥Conclusion:
Among critically ill patients with AKI, an accelerated renal-replacement strategy was NOT associated with a lower risk of death at 90 days than a standard strategy.
End/ --> thank you 🙏

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