Regional Practice Variation in the Management of Renal Replacement Therapy Modalities in the STARRT-AKI Trial
Why this work is in the frame
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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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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 it