title: Early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury (The ELAIN-Trial): study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Acute kidney injury remains a common complication in critically ill patients and despite multiple trials and observational studies, the optimal timing for initiation of renal replacement therapy is still unclear. The early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury (ELAIN) study is a randomized, single-center, prospective, two-arm, parallel group trial to reduce mortality in patients with severe acute kidney injury. We describe the study design and discuss aspects of the need for a trial in this patient cohort.
  
  
  METHODS
  Our plan is to randomize critically ill patients with acute kidney injury to 'early' or 'late' initiation of renal replacement therapy according to stage 2 and 3 of the KDIGO classification using a specific trial protocol. We plan to guide data collection and analysis using pre-existing definitions and testing. The primary endpoint is overall survival in a 90-day follow-up period. Secondary endpoints include 28-day, 60-day, 90-day and 1-year all-cause mortality, recovery of renal function, ICU and hospital length-of-stay. The primary analysis will be an intention-to-treat analysis; secondary analyses include treated analyses. We will also specify rules for handling data and determining outcome.
  
  
  CONCLUSIONS
  Several challenges for study design and execution can be seen in our trial, and it should generate results that will inform and influence the practice of renal replacement therapy in critically ill patients with acute kidney injury.
  
  
  BACKGROUND
  German Clinical Trials Register: DRKS00004367 ( www.germanctr.de ); 28 May 2013.
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany. zarbock@uni-muenster.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Zarbock
authors.affiliation: Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Gerß
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
authors.forename: Hugo
authors.initials: H
authors.lastname: Van Aken
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
authors.forename: Andreea
authors.initials: A
authors.lastname: Boanta
authors.affiliation: Department of Critical Care Medicine, Clinical Research, Investigation, and System Modelling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
authors.forename: Melanie
authors.initials: M
authors.lastname: Meersch
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D016638:Critical Illness; D005260:Female; D005858:Germany; D006801:Humans; D057194:Intention to Treat Analysis; D007668:Kidney / Q000503:physiopathology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012107:Research Design; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute kidney injury; Clinical trial; Critically ill patients; Renal replacement therapy