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Comment & Response
September 20, 2016

Timing of Initiation of Renal Replacement Therapy in Critically Ill Patients With Acute Kidney Injury

Author Affiliations
  • 1Medical Research Institute of New Zealand, Wellington, New Zealand
  • 2Intensive Care Unit, Austin Hospital, Melbourne, Australia
  • 3Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
JAMA. 2016;316(11):1213-1214. doi:10.1001/jama.2016.11323

To the Editor Dr Zarbock and the authors of the ELAIN trial1 studied the appropriate timing of RRT in critically ill patients. However, we are concerned that clinicians may now overestimate the odds that early initiation of RRT reduces mortality in the critically ill. The ELAIN trial investigators acknowledged that the magnitude of the observed mortality reduction with early initiation of dialysis was likely to be overestimated in their trial. They powered their trial to detect an even greater difference (an 18% absolute reduction in mortality) than they actually found (a 15% absolute reduction in mortality), suggesting that the treatment effect used to inform their sample size calculations was inflated.2