"Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients"

The RENAL Replacement Therapy Study Investigators

ABSTRACT

Background: "The optimal intensity of continuous renal-replacement therapy remains unclear. We conducted a multicenter, randomized trial to compare the effect of this therapy, delivered at two different levels of intensity, on 90-day mortality among critically ill patients with acute kidney injury."

Methods: "We randomly assigned critically ill adults with acute kidney injury to continuous renal-replacement therapy in the form of postdilution continuous venovenous hemodiafiltration with an effluent flow of either 40 ml per kilogram of body weight per hour (higher intensity) or 25 ml per kilogram per hour (lower intensity). The primary outcome measure was death within 90 days after randomization."

Results: "Of the 1508 enrolled patients, 747 were randomly assigned to higher-intensity therapy, and 761 to lower-intensity therapy with continuous venovenous hemodiafiltration. Data on primary outcomes were available for 1464 patients (97.1 per cent): 721 in the higher-intensity group and 743 in the lower-intensity group. The two study groups had similar baseline characteristics and received the study treatment for an average of 6.3 and 5.9 days, respectively (P=0.35). At 90 days after randomization, 322 deaths had occurred in the higher-intensity group and 332 deaths in the lower-intensity group, for a mortality of 44.7 per cent in each group (odds ratio, 1.00; 95 per cent confidence interval [CI], 0.81 to 1.23; P=0.99). At 90 days, 6.8 per cent of survivors in the higher-intensity group (27 of 399), as compared with 4.4 per cent of survivors in the lower-intensity group (18 of 411), were still receiving renal-replacement therapy (odds ratio, 1.59; 95 per cent CI, 0.86 to 2.92; P=0.14). Hypophosphatemia was more common in the higher-intensity group than in the lower-intensity group (65 per cent vs. 54 per cent, P<0.001)."

Conclusions: "In critically ill patients with acute kidney injury, treatment with higher-intensity continuous renal-replacement therapy did not reduce mortality at 90 days."

Source Information

The Randomized Evaluation of Normal versus Augmented Level (RENAL) Replacement Therapy Study is a collaboration of the Australian and New Zealand Intensive Care Society Clinical Trials Group and the George Institute for International Health. The members of the Writing Committee for the RENAL Replacement Therapy Study (Rinaldo Bellomo, M.D., Alan Cass, M.D., Ph.D., Louise Cole, M.D., Ph.D., Simon Finfer, M.D., Martin Gallagher, M.D., Serigne Lo, Ph.D., Colin McArthur, M.D., Shay McGuinness, M.D., John Myburgh, M.D., Ph.D., Robyn Norton, M.D., Ph.D., M.P.H., Carlos Scheinkestel, M.D., and Steve Su, Ph.D.) take responsibility for the content of this article.

Address reprint requests to Dr. Bellomo at ANZICS CTG, Level 3, 10 Ievers St., Carlton, VIC 3053, Australia, or at ctg@anzics.com.au.

Source:
http://content.nejm.org