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Factors associated with adverse haemodynamic events during the STARRT-AKI trial: a post-hoc secondary analysis
Kelly, Yvelynne P. da Costa, Bruno R. Beaubien-Souligny, William Clark, Edward G. Murray, Patrick T. Nichol, Alistair Wald, Ron Bagshaw, Sean M. The STandard vs. Accelerated initiation of Renal ReplacementTherapy in Acute Kidney Injury (STARRT-AKI) Investigators
Kelly, Yvelynne P.
da Costa, Bruno R.
Beaubien-Souligny, William
Clark, Edward G.
Murray, Patrick T.
Nichol, Alistair
Wald, Ron
Bagshaw, Sean M.
The STandard vs. Accelerated initiation of Renal ReplacementTherapy in Acute Kidney Injury (STARRT-AKI) Investigators
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2025-12-29
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Abstract
Introduction: Haemodynamic adverse events related to renal replacement therapy are a complication of all RRT modalities used in the ICU, including intermittent haemodialysis (IHD), sustained low efficiency dialysis (SLED) and continuous renal replacement therapy (CRRT). At present it is unclear which risk factors predispose to HAE and whether these contribute to adverse patient outcomes. Methods: We performed a secondary analysis of the multinational STARRT-AKI trial to assess factors associated with the occurrence of haemodynamic adverse events (HAE) in patients receiving RRT and whether these HAE were associated with less favourable clinical outcomes. The primary analysis was a multivariable Cox proportional hazards model based on the least absolute shrinkage and selection operator (LASSO), which included time to HAE as the dependent variable. Results: Factors significantly associated with an increased hazard ratio (HR) for HAE during RRT were a higher SOFA score at RRT initiation (HR 1.05; 95% 1.00-1.10), use of IHD as the initial RRT modality in comparison to CRRT (HR 1.74; 95% CI 1.28–2.37) and use of SLED as the initial RRT modality in comparison to CRRT (HR 2.73; 95% CI 1.65–4.51). In a multivariable analysis, adjusted for baseline patient characteristics and RRT initiation covariates, there was no significant association between the occurrence of a HAE during RRT and mortality, dialysis dependence, length of stay, RRT-free days, ventilator-free days or vasoactive-free days, respectively. There was, however, a significant association between multiple haemodynamic adverse events and all-cause mortality at 90 days. Conclusions: In this secondary analysis of the STARRT-AKI trial, the use of intermittent RRT modalities and higher severity of illness were associated with HAE during RRT. These events were not significantly associated with adverse clinical outcomes, apart from a significant association between multiple HAE and all-cause mortality at 90 days.
Citation
Kelly, Y.P., da Costa, B.R., Beaubien-Souligny, W. et al. Factors associated with adverse haemodynamic events during the STARRT-AKI trial: a post-hoc secondary analysis. Critical Care 29, 534 (2025). https://doi.org/10.1186/s13054-025-05693-0
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Research Unit
PubMed ID
41466322 (pubmed)
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Journal article
Language
en
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© 2025 The Authors. Published by Springer Nature. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1186/s13054-025-05693-0
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ISSN
1364-8535
EISSN
1466-609X
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Sponsors
The STARRT-AKI trial was funded by the following sources: Canadian Institutes of Health Research (Open Operating Grant MOP142296 and Project Grant 389635); Canadian Institutes of Health Research in partnership with Baxter (Industry-Partnered Operating Grant IPR 139081); National Health Medical Research Council of Australia (Project Grant 1127121); the Health Research Council of New Zealand (Project Grant 17/204) and the National Institutes of Health Research Health Technology Assessment Program (United Kingdom) (Reference Number: 17/42/74). Dr. Bagshaw is supported by a Canada Research Chair in Critical Care Outcomes and Systems Evaluation. Dr. Kelly received an Early Career Researcher Award from the Irish Critical Care Clinical Trials Network in support of this research.