Starting with intermittent haemodialysis in ICU acute kidney injury was linked to higher mortality than continuous therapy

The edition in brief

ICRAKI, published in NEJM on 14 October, randomised 554 critically ill adults with acute kidney injury needing renal replacement therapy to intermittent haemodialysis or continuous renal replacement therapy as the first modality. It was stopped early for a sustained mortality signal. Major adverse kidney events by day 90 occurred in 78.1% against 71.6%, so non-inferiority was not shown, and day-90 mortality was 63.3% against 53.6% (HR 1.30, 95% CI 1.04 to 1.63). Hypotension rates were similar. A prespecified FLOW analysis in Kidney International found fewer serious adverse events with semaglutide than placebo across all eGFR groups, including below 30, with more gastrointestinal discontinuations (4.5% against 1.1%). A French REIN registry analysis of 5,534 dialysis patients after an atherosclerotic event found statin initiation associated with lower mortality (four-year risk difference -6.2%) and no excess muscle or liver harm; it is observational and current guidance on starting statins in dialysis has not changed. A CRIC analysis of 3,826 people with CKD found both high and low hepcidin associated with adverse outcomes. The pearl covers urgent indications for dialysis in AKI.