Regional Practice Variation in the Management of Renal Replacement Therapy Modalities in the STARRT-AKI Trial
Bibliographic record
Abstract
Introduction: The assess whether, in high-income countries, in the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial, the management of the chosen initial renal replacement therapy modality varied by region and whether such variation was associated with different outcomes. METHODS: Post hoc analysis of the STARRT-AKI trial, including 142 ICUs in 13 countries. We evaluated 1,395 patients with severe AKI from North America, Europe, and Australia-New Zealand (ANZ) who received continuous renal replacement therapy (CRRT) as a first modality and 684 patients from North America and Europe who received intermittent hemodialysis (IHD) as a first modality. RESULTS: Among CRRT-first patients, femoral vascular access (p < 0.001) and citrate anticoagulation were more common in Europe and ANZ (p < 0.001) before and after adjustment for baseline characteristics. Treatment in ANZ was independently associated with a more negative fluid balance (p = 0.029), less frequent transition to IHD (p = 0.040), and lower CRRT dose-intensity (p = 0.012). Among IHD-first patients, compared to Europe, treatment in North America was independently associated with less use of femoral access, and greater net ultrafiltration rate. CONCLUSION: At STARRT-AKI trial centers, there was significant region-dependent practice variation in the management of CRRT-first and IHD-first patients. .
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".