Optimizing the Design and Analysis of Future AKI Trials.

Fiche publication

Date publication

juillet 2022

Journal

Journal of the American Society of Nephrology : JASN

Auteurs

Membres identifiés du Cancéropôle Est :
Pr ROSSIGNOL Patrick

Tous les auteurs :
Legrand M, Bagshaw SM, Koyner JL, Schulman IH, Mathis MR, Bernholz J, Coca S, Gallagher M, Gaudry S, Liu KD, Mehta RL, Pirracchio R, Ryan A, Steubl D, Stockbridge N, Erlandsson F, Turan A, Wilson FP, Zarbock A, Bokoch MP, Casey JD, Rossignol P, Harhay MO

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/35831022

Résumé

AKI is a complex clinical syndrome associated with an increased risk of morbidity and mortality, particularly in critically ill and perioperative patient populations. Most AKI clinical trials have been inconclusive, failing to detect clinically important treatment effects at predetermined statistical thresholds. Heterogeneity in the pathobiology, etiology, presentation, and clinical course of AKI remains a key challenge in successfully testing new approaches for AKI prevention and treatment. This article, derived from the "AKI" session of the "Kidney Disease Clinical Trialists" virtual workshop held in October 2021, reviews barriers to and strategies for improving the design and implementation of clinical trials in patients with, or at risk of, developing AKI. The novel approaches to trial design included in this review span adaptive trial designs that increase the knowledge gained from each trial participant; pragmatic trial designs that allow for the efficient enrollment of sufficiently large numbers of patients to detect small, but clinically significant, treatment effects; and platform trial designs that use one trial infrastructure to answer multiple clinical questions simultaneously. This review also covers novel approaches to clinical trial analysis, such as Bayesian analysis and assessing heterogeneity in the response to therapies among trial participants. We also propose a road map and actionable recommendations to facilitate the adoption of the reviewed approaches. We hope that the resulting road map will help guide future clinical trial planning, maximize learning from AKI trials, and reduce the risk of missing important signals of benefit (or harm) from trial interventions.