August 2, 2016
Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock.
What was the research question?
Does early vasopressin use, titrated up to 0.06 U/min improve kidney outcomes compared with norepinephrine in patients with septic shock requiring vasopressors?
How did they do it?
A factorial (2X2), double-blind, randomized clinical trial with 1:1:1:1 assignment in 18 Intensive Care Units in the United Kingdome
Included adult patients who had septic shock requiring vasopressors despite fluid resuscitation within a maximum of 6 hours after the onset of shock.
409 patients were randomly allocated to vasopressin (titrated up to 0.06 U/min) and hydrocortisone (n = 101), vasopressin and placebo (n = 104), norepinephrine and hydrocortisone (n = 101), or norepinephrine and placebo (n = 103).
The primary outcome was kidney failure–free days during the 28-day period after randomization.
Secondary outcomes were rates of renal replacement therapy, mortality, and serious adverse events were secondary outcomes.
What did they find?
Rate of survivors who never developed kidney failure in the vasopressin group was not statistically different than those in the vasopressin group (57.0% vs, 59.2%, difference, −2.3% [95% CI, −13.0% to 8.5%]).
The median number of kidney failure–free days for patients who did not survive, who experienced kidney failure, or both was 9 days in the vasopressin group and 13 days in the norepinephrine group (difference, −4 days [95% CI, −11 to 5]).
There was less use of renal replacement therapy in the vasopressin group than in the norepinephrine group (25.4% vs. 35.3%; difference, −9.9% [95% CI, −19.3% to −0.6%]).
There was no significant difference in mortality rates between groups.
10.7% had a serious adverse event in the vasopressin group vs. 8.3% in the norepinephrine group (difference, 2.5% [95% CI, −3.3% to 8.2%]).
What does it mean?
Early use of vasopressin compared with norepinephrine did not improve the number of kidney failure–free days in adults with septic shock.
These findings do not support the use of vasopressin as a first line treatment replacing norepinephrine, however, the confidence interval included a potential clinically important benefit for vasopressin.