Immediate or delayed initiation of renal replacement therapy in patients with leptospirosis and acute kidney injury: a target trial emulation
Abstract Background Anecdotal evidence suggests that early renal replacement therapy (RRT) may improve the mortality associated with acute kidney injury (AKI) in patients with leptospirosis. Conversely, several randomized controlled trials (RCTs) conducted in intensive care units have refuted the po...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2025-05-01
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| Series: | Annals of Intensive Care |
| Online Access: | https://doi.org/10.1186/s13613-025-01477-5 |
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| author | Marie Julien Cédric Rafat Loïc Raffray Henri Vacher-Coponat Nicolas Allou Jérôme Allyn Julien Jabot Yannis Lombardi |
| author_facet | Marie Julien Cédric Rafat Loïc Raffray Henri Vacher-Coponat Nicolas Allou Jérôme Allyn Julien Jabot Yannis Lombardi |
| author_sort | Marie Julien |
| collection | DOAJ |
| description | Abstract Background Anecdotal evidence suggests that early renal replacement therapy (RRT) may improve the mortality associated with acute kidney injury (AKI) in patients with leptospirosis. Conversely, several randomized controlled trials (RCTs) conducted in intensive care units have refuted the positive impact of early RRT on mortality in patients with AKI and other causes of sepsis. Methods In this emulated RCT utilizing a propensity score-weighted logistic regression performed in the two academic centers on the island of La Réunion, France, between 2010 and 2020, we evaluated the impact of the timing of RRT on a composite outcome of mortality or new-onset or worsening chronic kidney disease (CKD) within a year, in patients hospitalized with leptospirosis, Stage 3 AKI, and no immediate need for RRT. Results We included 295 consecutive patients with leptospirosis and Stage 3 AKI: 82 (28%) began RRT within 48 h of admission (“early” group), 213 (72%) did not start RRT within 48 h (“delayed” group). In the delayed group, 53/213 (25%) patients eventually required RRT. 59/295 patients (20%) met the primary outcome: 32 (15%) in the delayed group and 27 (33%) in the early group. The odds ratio (OR) for primary outcome occurrence before weighing was 2.78 (95% confidence interval CI 1.53 to 5.01, p < 0.001; reference: delayed group) and after weighting was 2.08 (95% CI: 1.01 to 4.26, p = 0.046). In secondary analyses, there was a significantly higher probability of CKD occurrence in the early group (OR 2.74, 95% CI 1.25 to 6.0, p = 0.012). Mortality at 1 year did not differ between groups (OR 0.76, 95% CI 0.21 to 2.68, p = 0.666). Conclusion Early initiation of RRT may be associated with an increased risk of death and development of CKD within 1 year in patients with leptospirosis and Stage 3 AKI. |
| format | Article |
| id | doaj-art-3f4cf86860fc4fe5b135dc1c861cb74b |
| institution | DOAJ |
| issn | 2110-5820 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj-art-3f4cf86860fc4fe5b135dc1c861cb74b2025-08-20T03:07:51ZengSpringerOpenAnnals of Intensive Care2110-58202025-05-0115111110.1186/s13613-025-01477-5Immediate or delayed initiation of renal replacement therapy in patients with leptospirosis and acute kidney injury: a target trial emulationMarie Julien0Cédric Rafat1Loïc Raffray2Henri Vacher-Coponat3Nicolas Allou4Jérôme Allyn5Julien Jabot6Yannis Lombardi7Nephrology Unit, Centre Hospitalier Universitaire Felix GuyonRenal Intensive Care Unit, Tenon Hospital, Assistance Publique-Hôpitaux de ParisDepartment of Internal Medicine, Félix-Guyon University Hospital of La RéunionNephrology Unit, Centre Hospitalier Universitaire Felix GuyonIntensive Care Unit, Centre Hospitalier UniversitaireIntensive Care Unit, Centre Hospitalier UniversitaireIntensive Care Unit, Centre Hospitalier UniversitaireRenal Intensive Care Unit, Tenon Hospital, Assistance Publique-Hôpitaux de ParisAbstract Background Anecdotal evidence suggests that early renal replacement therapy (RRT) may improve the mortality associated with acute kidney injury (AKI) in patients with leptospirosis. Conversely, several randomized controlled trials (RCTs) conducted in intensive care units have refuted the positive impact of early RRT on mortality in patients with AKI and other causes of sepsis. Methods In this emulated RCT utilizing a propensity score-weighted logistic regression performed in the two academic centers on the island of La Réunion, France, between 2010 and 2020, we evaluated the impact of the timing of RRT on a composite outcome of mortality or new-onset or worsening chronic kidney disease (CKD) within a year, in patients hospitalized with leptospirosis, Stage 3 AKI, and no immediate need for RRT. Results We included 295 consecutive patients with leptospirosis and Stage 3 AKI: 82 (28%) began RRT within 48 h of admission (“early” group), 213 (72%) did not start RRT within 48 h (“delayed” group). In the delayed group, 53/213 (25%) patients eventually required RRT. 59/295 patients (20%) met the primary outcome: 32 (15%) in the delayed group and 27 (33%) in the early group. The odds ratio (OR) for primary outcome occurrence before weighing was 2.78 (95% confidence interval CI 1.53 to 5.01, p < 0.001; reference: delayed group) and after weighting was 2.08 (95% CI: 1.01 to 4.26, p = 0.046). In secondary analyses, there was a significantly higher probability of CKD occurrence in the early group (OR 2.74, 95% CI 1.25 to 6.0, p = 0.012). Mortality at 1 year did not differ between groups (OR 0.76, 95% CI 0.21 to 2.68, p = 0.666). Conclusion Early initiation of RRT may be associated with an increased risk of death and development of CKD within 1 year in patients with leptospirosis and Stage 3 AKI.https://doi.org/10.1186/s13613-025-01477-5 |
| spellingShingle | Marie Julien Cédric Rafat Loïc Raffray Henri Vacher-Coponat Nicolas Allou Jérôme Allyn Julien Jabot Yannis Lombardi Immediate or delayed initiation of renal replacement therapy in patients with leptospirosis and acute kidney injury: a target trial emulation Annals of Intensive Care |
| title | Immediate or delayed initiation of renal replacement therapy in patients with leptospirosis and acute kidney injury: a target trial emulation |
| title_full | Immediate or delayed initiation of renal replacement therapy in patients with leptospirosis and acute kidney injury: a target trial emulation |
| title_fullStr | Immediate or delayed initiation of renal replacement therapy in patients with leptospirosis and acute kidney injury: a target trial emulation |
| title_full_unstemmed | Immediate or delayed initiation of renal replacement therapy in patients with leptospirosis and acute kidney injury: a target trial emulation |
| title_short | Immediate or delayed initiation of renal replacement therapy in patients with leptospirosis and acute kidney injury: a target trial emulation |
| title_sort | immediate or delayed initiation of renal replacement therapy in patients with leptospirosis and acute kidney injury a target trial emulation |
| url | https://doi.org/10.1186/s13613-025-01477-5 |
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