Randomized Trial of Early vs Standard Renal Replacement Therapy in Patients With Acute Kidney Injury After Type A Aortic Dissection.

Abstract

We sought to study whether early initiation of renal replacement therapy (RRT) could reduce 90-day mortality and improve clinical outcomes in patients with acute kidney injury after acute type A aortic dissection. This single-center, randomized, controlled trial enrolled acute type A aortic dissection patients with severe postoperative acute kidney injury classified as Kidney Disease: Improving Global Outcomes (KDIGO) stage 2 and with a plasma neutrophil gelatinase-associated lipocalin level >150 ng/mL who did not have potentially life-threatening complications directly related to renal failure. Patients were randomized equally into 2 groups: the early RRT group received RRT within 6 hours of diagnosis of KDIGO stage 2; the standard treatment group was managed with RRT initiated within 8 hours of stage 3. The primary outcome was mortality at 90 days. Secondary outcomes included in-hospital mortality, 30-day mortality, clinical evidence of organ dysfunction, duration of RRT, and intensive care unit and hospital lengths of stay. Among 212 patients, all patients in the early group (n =106) and 100 of 106 patients in the standard treatment group received RRT. Early initiation of RRT significantly reduced 90-day mortality (30.2%) compared with standard initiation (51.9%; P = .001). In-hospital mortality was lower in the early group (24.5% vs 38.7%; P = .03), and 30-day mortality was also reduced (28.3% vs 43.4%; P = .02). Nevertheless, there was no significant difference in organ dysfunction or in intensive care unit and hospital lengths of stay. Our results revealed that early initiation of RRT improves patient prognosis.