No improvement in kidney failure-free days versus norepinephrine in adults with septic shock
WEDNESDAY, Aug. 3, 2016 (HealthDay News) — Among adults with septic shock, early use of vasopressin does not improve the number of kidney failure-free days versus norepinephrine, according to a study published in the Aug. 2 issue of the Journal of the American Medical Association.
Anthony C. Gordon, M.D., from Imperial College London, and colleagues compared the effect of early vasopressin versus norepinephrine on kidney failure. Adult patients with septic shock requiring vasopressors were enrolled and randomized to vasopressin and hydrocortisone (101 patients), vasopressin and placebo (104 patients), norepinephrine and hydrocortisone (101 patients), or norepinephrine and placebo (103 patients).
The researchers found that 57.0 percent of survivors in the vasopressin group and 59.2 percent in the norepinephrine group never developed kidney failure (difference, −2.3 percent [95 percent confidence interval (CI), −13.0 to 8.5 percent]). For patients who did not survive, who experienced kidney failure, or both, the median number of kidney failure-free days was nine days in the vasopressin group and 13 days in the norepinephrine group (difference, −4 days [95 percent CI, −11 to 5]). The vasopressin group had less use of renal replacement therapy (25.4 versus 35.3 percent; difference, −9.9 percent [95 percent CI, −19.3 to −0.6 percent]). Just over 10 percent (10.7 percent) had a serious adverse event in the vasopressin group compared to 8.3 percent in the norepinephrine group (difference, 2.5 percent [95 percent CI, −3.3 to 8.2 percent]).
“Although these findings do not support the use of vasopressin to replace norepinephrine as initial treatment in this situation, the confidence interval included a potential clinically important benefit for vasopressin, and larger trials may be warranted to assess this further,” the authors write.
One author disclosed financial ties to the pharmaceutical industry.
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