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Comment & Response |

Timing of Initiation of Renal Replacement Therapy in Critically Ill Patients With Acute Kidney Injury

Paul J. Young, PhD1; Rinaldo Bellomo, MD2; Giovanni Landoni, MD3
[+] Author Affiliations
1Medical Research Institute of New Zealand, Wellington, New Zealand
2Intensive Care Unit, Austin Hospital, Melbourne, Australia
3Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
JAMA. 2016;316(11):1213-1214. doi:10.1001/jama.2016.11323.
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To the Editor Dr Zarbock and the authors of the ELAIN trial1 studied the appropriate timing of RRT in critically ill patients. However, we are concerned that clinicians may now overestimate the odds that early initiation of RRT reduces mortality in the critically ill. The ELAIN trial investigators acknowledged that the magnitude of the observed mortality reduction with early initiation of dialysis was likely to be overestimated in their trial. They powered their trial to detect an even greater difference (an 18% absolute reduction in mortality) than they actually found (a 15% absolute reduction in mortality), suggesting that the treatment effect used to inform their sample size calculations was inflated.2

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May 24, 2016
Alexander Zarbock, MD; John A. Kellum, MD; Christoph Schmidt, MD; Hugo Van Aken, MD; Carola Wempe, PhD; Hermann Pavenstädt, MD; Andreea Boanta, MD; Joachim Gerß, PhD; Melanie Meersch, MD
1Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Germany
2Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pennsylvania
3Department of Internal Medicine D, University Hospital Münster, Germany
4Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
JAMA. 2016;315(20):2190-2199. doi:10.1001/jama.2016.5828.
September 20, 2016
Alexander Zarbock, MD; John A. Kellum, MD
1Department of Anaesthesiology, Intensive Care Medicine, and Pain Medicine, University Hospital Münster, Germany
2Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA. 2016;316(11):1214. doi:10.1001/jama.2016.11338.
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