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

Background: We seek 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 following acute type A aortic dissection.

Methods: This is a single-center, randomized, controlled trial that enrolled acute type A aortic dissection patients with severe post-operative acute kidney injury (Kidney Disease: Improving Global Outcomes (KDIGO) stage 2) and with 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 two 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 length of intensive care unit and hospital stays.

Results: Among 212 patients, all patients in the early group (n =106) and 100 of 106 patients in the standard treatment group received RRT. In this study, Early initiation of RRT significantly reduced 90-day mortality (30.2%) compared with standard initiation (51.9%;P =0.001). In-hospital mortality in the early group (24.5% vs 38.7%; P =0.03) was lower. It also reduced 30-day mortality (28.3% vs 43.4%; P =0.02). Nevertheless, there was no significant difference in organ dysfunction and length of intensive care unit and hospital stay.

Conclusions: Our results revealed that early initiation of RRT improve patient's prognosis.