Chapter 27 Other (non-renal) specialties

Landmark trials in other (non-renal specialties) that are nonetheless relevant to many ‘renal’ patients.

27.1 Critical care

27.1.1 Sepsis

SEPSISPAM (2014): comparing high- (80–85 mmHg) vs. low (65–70 mmHg) MAP targets in septic shock. No difference in mortality at 28 days. In patients with pre-existing HTN, high-target group required less RRT.

RCTs testing the complex intervention of early goal-directed therapy:

RIVERS et al (2001): comparing early goal-directed therapy vs. usual care in septic shock (n=263). In-hospital mortality lower in EGDT group.

PRISM meta-analysis (2017): - patient-level meta-analysis of ProCESS, ARISE and ProMISE trials of EGDT vs. usual care in septic shock (n=3723). No benefit (for 90-day mortality) for EGDT.

See also section on IV fluids.

27.2 Cardiology

HOPE (2000): - ramipril vs. placebo in high-risk patients with vascular disease or diabetes (but not known HFrEF). Rampril reduced risk of death, MI and stroke.

CONSENSUS (1987): - enalapril vs. placebo in NYHA class IV CCF. Mortality benefit seen in enalapril group.

SOLVD (1991): - enalapril vs. placebo in patients with HFrEF (EF < 0.35) - predominantly NYHA II and III. Enalapril reduced all-cause mortality and rates of hospitalisation for and death from heart failure.

27.3 Haematology

BRIDGE (2015): LMWH vs. placebo for peri-operative “bridging anticoagulation” in patients warfarinised for AF. Placebo was non-inferior w.r.t. risk of CVA, VTE or TIA and superior w.r.t. risk of major bleeding.