Intermittent haemodialysis first in critically ill AKI was linked to more deaths than continuous therapy, and the trial stopped early

The edition in brief

ICRAKI, a French open-label trial in 554 critically ill adults with acute kidney injury needing dialysis, was stopped early because starting with intermittent haemodialysis was associated with higher 90-day mortality than starting with continuous renal replacement therapy (63% vs 54%, HR 1.30). It failed to show non-inferiority on its composite kidney outcome. In IMPALA, 540 adults in Kenya, South Africa and Uganda with suppressed HIV but adherence problems were randomised to cabotegravir plus rilpivirine injections every eight weeks or daily oral dolutegravir-based therapy; viral suppression at 48 weeks was 91% vs 89%, meeting non-inferiority, with five confirmed virological failures only in the injectable group. VASSPR, a cluster crossover trial of 3,959 patients with septic shock, found that starting vasopressin at a lower noradrenaline dose did not change 28-day mortality (31.8% vs 33.0%). The ACID trial of 2,267 people under Barrett's surveillance found acetic acid chromoendoscopy doubled the number of suspected lesions but did not raise the neoplasia detection rate. The pearl covers dose-response checks before blaming adherence for treatment failure.