In critically ill patients with severe acute kidney injury (AKI), initiation of continuous renal replacement therapy (CRRT), as compared to intermittent hemodialysis (IHD), was associated with a significant reduction in the composite outcome of death or RRT dependence at 90-days.

In this secondary analysis of the STARRT-AKI trial, the initial receipt of CRRT, as compared to IHD, was associated with a significant reduction in the risk of death or RRT dependence at 90-days, largely driven by a lower risk of RRT dependence.

These observations provide new knowledge on the potential link between RRT modality and kidney recovery.

While hypothesis generating, our findings should serve as a springboard for future randomized trials that can more rigorously assess the impact of RRT modality on clinical outcomes and healthcare costs.

We identified 1,590 trial participants who initially received CRRT and 606 who initially received IHD.

The composite outcome of death or RRT dependence at 90-days occurred in 823 (51.8%) patients who commenced CRRT and 329 (54.3%) patients who commenced IHD (unadjusted odds ratio (OR) 0.90; 95% confidence interval (CI) 0.75–1.09).

After balancing baseline characteristics with overlap weighting, initial receipt of CRRT was associated with a lower risk of death or RRT dependence at 90-days compared with initial receipt of IHD (OR 0.81; 95% CI 0.66–0.99).

This association was predominantly driven by a lower risk of RRT dependence at 90-days (OR 0.61; 95% CI 0.39–0.94).

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