Boulos J, Darawsha W, Abassi ZA, Azzam ZS, Aronson D. Treatment patterns of patients with acute heart failure who develop acute kidney injury. ESC Heart Fail. 2019;6(1):45–52.
PubMed link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351897/
Full text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351897/pdf/EHF2-6-45.pdf
| Methods | Study design: Prospective cohort
Number of groups: 2 |
| Participants | Number of participants: 277
Age: 79 ± 11 Female: 139 (50%) Participants with dementia: Unclear Inclusion criteria: Hospitalised with new-onset or worsening heart failure Brain natriuretic peptide level >400pg/mL at admission Acute kidney injury (maximal increase >0.3mg/dL serum creatinine) during admission Exclusion criteria: nil Country: Israel Setting: 1000-bed academic medical centre |
| Interventions | Medicine: Angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, spironolactone, or diuretics
Intervention: Physician-directed reduction or discontinuation of medications as acute kidney injury developed Withdrawal schedule: Not described |
| Outcomes | Reduced or discontinued medicines
Episodes of hypertension/hypotension In-hospital mortality 6-month readmission or mortality Renal function recovery (serum creatinine, blood urea nitrogen) Length of hospital stay |
| Dates | Dates: January 2008 to April 2014
Follow-up duration: 6 months |
| Funding sources | Nil reported |
| Notes |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | Low | Single arm study, all eligible patients assessed |
| Allocation concealment (selection bias) | Low | Single arm study |
| Blinding of participants and personnel (performance bias) | High | Not described |
| Blinding of outcome assessment (detection bias) | High | Not described |
| Incomplete outcome data (attrition bias) | Unclear | Reasons for loss to follow-up not reported |
| Selective reporting (reporting bias) | Unclear | No protocol described |
| Confounding (non-randomized) | Low | Confounders described and included in analysis plans |
| Other bias | ||
| Selection bias | Representativeness of the exposed cohort | Consecutive or representative series of cases |
| Selection of the non-exposed cohort | N/A | |
| Ascertainment of exposure | Secure records | |
| Demonstration that outcome of interest was not present at start of study | Yes | |
| Comparability bias | Comparability of cohorts on the basis of the design or analysis | Study controls for medication withdrawal |
| Outcome bias | Assessment of outcome | Secure record |
| Was follow-up long enough for outcomes to occur | Yes | |
| Adequacy of follow-up of cohorts | Same rate for both groups | |
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