Intermittent dialysis as first choice in ICU kidney injury linked to higher mortality; trial stopped early

The edition in brief

ICRAKI randomised 554 critically ill adults with acute kidney injury and an indication for renal-replacement therapy to initial intermittent haemodialysis or continuous therapy. It stopped early after interim analyses showed a sustained signal of higher mortality with intermittent dialysis. Major adverse kidney events at day 90 were 78.1% vs 71.6% (adjusted risk difference 6.28 percentage points, 95% CI -1.22 to 13.79), noninferiority was not shown, and day-90 mortality was 63.3% vs 53.6% (HR 1.30, 95% CI 1.04 to 1.63). VASSPR, a cluster-crossover trial across 13 hospitals in 3,959 patients with septic shock, found that starting vasopressin at a lower background vasopressor dose (0.1 vs 0.4 micrograms per kg per minute of noradrenaline equivalent) did not change 28-day mortality (31.8% vs 33.0%; adjusted OR 0.98, 95% CI 0.87 to 1.06). IMPALA, an open-label trial of 540 adults in Kenya, South Africa and Uganda with HIV and adherence difficulties, found long-acting cabotegravir plus rilpivirine every 8 weeks noninferior to oral dolutegravir-based therapy for viral load below 50 copies per mL at 48 weeks (91.0% vs 89.2%), with confirmed virologic failure in 5 participants (1.9%) vs none.