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Comment & Response |

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

Alexander Zarbock, MD1; John A. Kellum, MD2
[+] Author Affiliations
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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In Reply Drs Vinsonneau and Monchi and Dr Wang and colleagues point out that the study designs of the ELAIN and AKIKI1 trials differ. For example, patients in the ELAIN trial were treated earlier and were more severely ill compared with patients in the AKIKI trial. We believe that the pivotal difference between ELAIN and AKIKI is the time at which RRT was initiated. This is important because AKI can result in systemic disease affecting inflammation and function of different organs. Early treatment may attenuate the levels of pro-inflammatory mediators and subsequently reduce organ dysfunction.


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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
Christophe Vinsonneau, MD, MSc; Mehran Monchi, MD
1Intensive Care Unit, Marc Jacquet Hospital, Melun, France
JAMA. Published online September 20, 2016.;():. doi:10.1001/jama.2016.11329.
September 20, 2016
Hong Wang, MD, PhD; Chenglong Li, MD; Xiaotong Hou, MD, PhD
1Beijing Anzhen Hospital, Capital Medical University, Beijing, China
JAMA. 2016;316(11):1212-1213. doi:10.1001/jama.2016.11320.
September 20, 2016
Paul J. Young, PhD; Rinaldo Bellomo, MD; Giovanni Landoni, MD
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.
September 20, 2016
Bruno Adler Maccagnan Pinheiro Besen, MD; Otavio T. Ranzani, MD, MSc; Marcelo Park, MD, PhD
1Medical Intensive Care Unit, University of São Paulo Medical School, São Paulo, Brazil
2Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
JAMA. 2016;316(11):1213. doi:10.1001/jama.2016.11332.
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