Impact of early versus conventional kidney replacement therapy initiation in tumor lysis syndrome: a target trial emulation
Abstract Background In the context of tumor lysis syndrome (TLS), the optimal timing and criteria for initiating kidney replacement therapy (KRT) remain unclear. This study aims to assess the effect of initiating KRT at various phosphatemia thresholds on Major Adverse Kidney Events at day 30 (MAKE30...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2025-04-01
|
| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-025-01439-x |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849765408436912128 |
|---|---|
| author | Justine Serre Guillaume Mulier Charlotte Boud’hors Marie Lemerle Moustafa Abdel-Nabey Corentin Orvain Anis Chaba Lucie Biard Julien Demiselle Lara Zafrani |
| author_facet | Justine Serre Guillaume Mulier Charlotte Boud’hors Marie Lemerle Moustafa Abdel-Nabey Corentin Orvain Anis Chaba Lucie Biard Julien Demiselle Lara Zafrani |
| author_sort | Justine Serre |
| collection | DOAJ |
| description | Abstract Background In the context of tumor lysis syndrome (TLS), the optimal timing and criteria for initiating kidney replacement therapy (KRT) remain unclear. This study aims to assess the effect of initiating KRT at various phosphatemia thresholds on Major Adverse Kidney Events at day 30 (MAKE30). Methods and results We retrospectively emulated a pragmatic clinical trial comparing the effect of KRT initiation at various phosphatemia thresholds versus a conventional approach during TLS on MAKE30. All consecutive patients admitted to the ICU at Saint-Louis University hospital in Paris and Angers University hospital between January 2007 and June 2020, presenting with laboratory TLS were included. The design criteria of a clinical trial were mimicked by using the cloning, censoring and weighting method. The primary outcome was the MAKE30 composite outcome, considering only KRT requirement between day 7 and day 30 for the dialysis criteria. We evaluated multiple phosphatemia thresholds to guide KRT initiation, ranging from 6.20 mg.dL-1 to 9.30 mg.dL-1. Among the initial population of 220 patients, 192 were included in the emulated trial (median age 60 years old, with non-Hodgkin Lymphoma and Acute Leukemia being the most frequent hematological malignancies). TLS-related AKI occurred in 140 patients, and 75 patients met the criteria for MAKE30. Regardless of the phosphate threshold considered, KRT initiation based on phosphate level was not associated with a significant difference in the MAKE30 rate. KRT requirement during the first 7 days (Odd Ratio [OR] 4.01 [1.65–4.86], p = 0.003) and non-renal SOFA (OR 1.39 per 1 point increment [1.25–1.57], p < 0.001) were identified as factors associated with MAKE30 (multivariable analysis). Conclusion Our results do not support the strategy of KRT initiation based on a sole critical phosphatemia level in TLS patients. |
| format | Article |
| id | doaj-art-5cdcd821ee6e4b2686c25a4c08489616 |
| institution | DOAJ |
| issn | 2110-5820 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj-art-5cdcd821ee6e4b2686c25a4c084896162025-08-20T03:04:53ZengSpringerOpenAnnals of Intensive Care2110-58202025-04-0115111010.1186/s13613-025-01439-xImpact of early versus conventional kidney replacement therapy initiation in tumor lysis syndrome: a target trial emulationJustine Serre0Guillaume Mulier1Charlotte Boud’hors2Marie Lemerle3Moustafa Abdel-Nabey4Corentin Orvain5Anis Chaba6Lucie Biard7Julien Demiselle8Lara Zafrani9Department of Medical Intensive Care, Hôpital Saint-Louis, AP-HPDepartment of Biostatistics and Medical Information, AP-HP, Hôpital Saint-Louis, Université Paris CitéDepartment of Nephrology, Dialysis, Transplantation, CHU AngersDepartment of Medical Intensive Care, CHU AngersDepartment of Medical Intensive Care, Hôpital Saint-Louis, AP-HPDepartment of Hematology, CHU AngersDepartment of Medical Intensive Care, Hôpital Saint-Louis, AP-HPDepartment of Biostatistics and Medical Information, AP-HP, Hôpital Saint-Louis, Université Paris CitéDepartment of Medical Intensive Care, Nouvel Hôpital Civil, Strasbourg University HospitalDepartment of Medical Intensive Care, Hôpital Saint-Louis, AP-HPAbstract Background In the context of tumor lysis syndrome (TLS), the optimal timing and criteria for initiating kidney replacement therapy (KRT) remain unclear. This study aims to assess the effect of initiating KRT at various phosphatemia thresholds on Major Adverse Kidney Events at day 30 (MAKE30). Methods and results We retrospectively emulated a pragmatic clinical trial comparing the effect of KRT initiation at various phosphatemia thresholds versus a conventional approach during TLS on MAKE30. All consecutive patients admitted to the ICU at Saint-Louis University hospital in Paris and Angers University hospital between January 2007 and June 2020, presenting with laboratory TLS were included. The design criteria of a clinical trial were mimicked by using the cloning, censoring and weighting method. The primary outcome was the MAKE30 composite outcome, considering only KRT requirement between day 7 and day 30 for the dialysis criteria. We evaluated multiple phosphatemia thresholds to guide KRT initiation, ranging from 6.20 mg.dL-1 to 9.30 mg.dL-1. Among the initial population of 220 patients, 192 were included in the emulated trial (median age 60 years old, with non-Hodgkin Lymphoma and Acute Leukemia being the most frequent hematological malignancies). TLS-related AKI occurred in 140 patients, and 75 patients met the criteria for MAKE30. Regardless of the phosphate threshold considered, KRT initiation based on phosphate level was not associated with a significant difference in the MAKE30 rate. KRT requirement during the first 7 days (Odd Ratio [OR] 4.01 [1.65–4.86], p = 0.003) and non-renal SOFA (OR 1.39 per 1 point increment [1.25–1.57], p < 0.001) were identified as factors associated with MAKE30 (multivariable analysis). Conclusion Our results do not support the strategy of KRT initiation based on a sole critical phosphatemia level in TLS patients.https://doi.org/10.1186/s13613-025-01439-xTumor lysis syndromeAcute kidney injuryKidney replacement therapy |
| spellingShingle | Justine Serre Guillaume Mulier Charlotte Boud’hors Marie Lemerle Moustafa Abdel-Nabey Corentin Orvain Anis Chaba Lucie Biard Julien Demiselle Lara Zafrani Impact of early versus conventional kidney replacement therapy initiation in tumor lysis syndrome: a target trial emulation Annals of Intensive Care Tumor lysis syndrome Acute kidney injury Kidney replacement therapy |
| title | Impact of early versus conventional kidney replacement therapy initiation in tumor lysis syndrome: a target trial emulation |
| title_full | Impact of early versus conventional kidney replacement therapy initiation in tumor lysis syndrome: a target trial emulation |
| title_fullStr | Impact of early versus conventional kidney replacement therapy initiation in tumor lysis syndrome: a target trial emulation |
| title_full_unstemmed | Impact of early versus conventional kidney replacement therapy initiation in tumor lysis syndrome: a target trial emulation |
| title_short | Impact of early versus conventional kidney replacement therapy initiation in tumor lysis syndrome: a target trial emulation |
| title_sort | impact of early versus conventional kidney replacement therapy initiation in tumor lysis syndrome a target trial emulation |
| topic | Tumor lysis syndrome Acute kidney injury Kidney replacement therapy |
| url | https://doi.org/10.1186/s13613-025-01439-x |
| work_keys_str_mv | AT justineserre impactofearlyversusconventionalkidneyreplacementtherapyinitiationintumorlysissyndromeatargettrialemulation AT guillaumemulier impactofearlyversusconventionalkidneyreplacementtherapyinitiationintumorlysissyndromeatargettrialemulation AT charlotteboudhors impactofearlyversusconventionalkidneyreplacementtherapyinitiationintumorlysissyndromeatargettrialemulation AT marielemerle impactofearlyversusconventionalkidneyreplacementtherapyinitiationintumorlysissyndromeatargettrialemulation AT moustafaabdelnabey impactofearlyversusconventionalkidneyreplacementtherapyinitiationintumorlysissyndromeatargettrialemulation AT corentinorvain impactofearlyversusconventionalkidneyreplacementtherapyinitiationintumorlysissyndromeatargettrialemulation AT anischaba impactofearlyversusconventionalkidneyreplacementtherapyinitiationintumorlysissyndromeatargettrialemulation AT luciebiard impactofearlyversusconventionalkidneyreplacementtherapyinitiationintumorlysissyndromeatargettrialemulation AT juliendemiselle impactofearlyversusconventionalkidneyreplacementtherapyinitiationintumorlysissyndromeatargettrialemulation AT larazafrani impactofearlyversusconventionalkidneyreplacementtherapyinitiationintumorlysissyndromeatargettrialemulation |